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The Economic Status of
Registered Professional Nurses
1946-47

Bulletin No. 931
UNITED STATES DEPARTMENT OF LABOR
L. B. Schwellenbach, Secretary
BUREAU OF LABOR STATISTICS
Ewan Clague,

For sale by the Superintendent of Documents, U. S. Government Printing Office, Washington 25, D. C.




C om m issioner

Price 30 cents

LETTER OF TRANSMITTAL
U nited States D epartment of L abor,
B ureau of L abor Statistics,

Washington, D . (7., December 9, 1947.
I have the honor to transmit herewith a report on the economic status of
registered professional nurses, which was made by the Bureau of Labor
Statistics in cooperation with the National Nursing Council and the Womens
Bureau of the United States Department of Labor.
The study was conducted and this report was prepared by Lily Mary David
of the Division of Wage Analysis of the Bureau of Labor Statistics. The
organizations and individuals to whom special credit is due for assistance in
various phases of the survey are listed in the preface.
E wan C lague, Commissioner.
Hon. L. B.
Secretary of Labor.
T he Secretary of L abor :

SCH W ELLENBACH,

n




PREFACE
This study of earnings and working conditions of registered professional nurses
was prompted by the critical postwar shortage of nursing care in the United States.
It was conducted early in 1947 by the Bureau of Labor Statistics at the request of
the National Nursing Council and in cooperation with the Women’s Bureau of the
U. S. Department of Labor.1
The Bureau of Labor Statistics was responsible for developing the questionnaire;
determining the methods to be used in selecting the persons to be included in the
study; actually selecting the names; editing questionnaires; planning and preparing
tabulations; and analyzing the results of the study. The study was jointly financed
by the Bureau of Labor Statistics and the National Nursing Council, and the
Metropolitan Life Insurance Co. provided part of the tabulating facilities.
In the course of developing the study, cooperation and advice was received not
only from the Women’s Bureau (which also participated in the planning of this
report) and the National Nursing Council, but from many other governmental and
nongovernmental organizations and individuals interested in improvement of the
country’s nursing standards and service.
Among the organizations whose representatives assisted in the development of
the survey were the following:
American Association of Industrial Nurses.
American Federation of State, County & Municipal Employees.
American Hospital Association
American Medical Association, Council on Medical Education and
Hospitals.
American Nurses’ Association.
Chicago Associate Nurses Union No. 21679.
District of Columbia Graduate Nurses’ Association.
National Association of Colored Graduate Nurses.
National League of Nursing Education.
National Organization for Public Health Nursing.
Registered Professional Nurses Association.
State nurses’ associations.
United Office & Professional Workers of America.
United Public Workers of America.
U. S. Department of Commerce, Bureau of Foreign and Domestic Com­
merce, Office of Business Economics, National Income Division.
U. S. Civil Service Commission, Medical Division.
U. S. Navy, Bureau of Medicine and Surgery.
U. S. Public Health Service.
U. S. Veterans’ Administration.
U. S. War Department, Office of the Surgeon General.*
l
I
i Preliminary reports on the study were published in the American Journal of Nursing, July, September, and October 1947,
and the Monthly Labor Review, July, September, and November 1947. The reports dealt with The Economic Status of Nurses,
Working Conditions of Public Health Nurses, and Working Conditions of Private Duty Nurses.




Ill

IV

PREFACE

Actual selection of nurses to receive the questionnaire was made possible by
cooperation of the boards of nurse examiners in every State in which current regis­
tration of nurses is maintained; they supplied lists of all nurses currently registered
in their States to be used in this selection. In four States (Maryland, North
Carolina, Ohio, and Wyoming) where annual or biennial registration was not in
effect, the State nurses7association made its membership list available for choice
of names.
Special credit is due Joseph Mayer and Vera Holtzclaw of the Division of
Wage Analysis, who were responsible respectively for collection of available infor­
mation on working conditions in other fields of work and for supervision of
tabulations. Cora E. Taylor, of the Division of Occupational Outlook, and
Marion Hammett, formerly of the Office of Publications, of the Bureau of Labor
Statistics; and Marguerite W. Zapoleon, of the Women7s Bureau, provided special
assistance in the planning stages of the study. Marjorie B. Davis, executive
secretary of the Planning Committee of the National Nursing Council, coordi­
nated the work of the nursing organizations that cooperated in the study and
personally contributed invaluable aid and advice.
Without the assistance of the 22,000 nurses who filled out the questionnaire
used in the survey the study would, of course, have been impossible.







CONTENTS
P reface_______________________________________________________
Summary_________________________________________________________________
The nursing shortage__________________________________________________
Earnings and expenses_________________________________________________
Hours________________________________________________________________
Vacations, sick leave, and insurance------------------------------------------------------Variations in working conditions among nursing fields______________________
Regional variations in working conditions-----------------------------------------------Duties________________________________________________________________
I ntroduction_____________________________________________________________
Part I. Active N urses_______________________________________________
Chapter 1.—Characteristics of the Nursing Profession_________________
Fields of nursing__________________________________________________
Numerical importance_________________________________________
Positions_____________________________________________________
Employers________________________________________________________
Geographic distribution____________________________________________
Age, experience, and education_____________________________________
Other characteristics_______________________________________________
Chapter 2.—Earnings and Hours, October 1946______________________
Earnings and supplementary maintenance____________________________
Monthly earnings_____________________________________________
Hourly earnings_______________________________________________
Supplementary maintenance----------------------------------------------------Regional differences___________________________________________
Factors in earnings variations__________________________________
Hours on duty____________________________________________________
Scheduled hours_______________________________________________
Actual hours on duty and overtime-------------------------------------------Regional differences in hours___________________________________
Factors in hours variations------------------------------------------------------Hours on call and split shifts________________
Variations in practices------------------------------------------------------------Overtime pay_____________________________________________________
Late-shift work and pay___________________________________________
Advance hours posting for institutional nurses____________________
Hours and earnings in 10 cities and Hawaii____________________________
Chapter 3.—Living Arrangements and Maintenance Allowances__________
Living arrangements_______________________________________________
Allowance for living out____________________________________________
Type of room provided_____________________________________________
Chapter 4.—Paid Vacations and Sick Leave_____________________________
Chapter 5.—Insurance, Retirement Provisions, and Medical Care__________
Chapter 6.—Professional Expenses______________________________________
Chapter 7.—Duties of Institutional Nurses_______________________________

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v

CONTENTS

VI

P art I. Active N urses—Continued
Pa&
*
Chapter 8.—Opinions----------------------------------------36
Variation among nursing fields-------------------------------------------------------40
Industrial, office, and public health-------------------------------------------40
Private duty__________________________________________________
41
Nurse educators_______________________________________________ 42
Institutional__________________________________________________
42
Regional differences in opinions_____________________________________
44
Factors in opinions________________________________________________
45
P art II. I nactive N urses-----------------47
Chapter 1.—Employment Status and Reasons for Leaving Nursing_____
47
Social and economic factors_________________________________________ 48
The postwar problem______________________________________________
49
Chapter 2.—Characteristics_____________________________________________ 50
P art III. Comparison With E arnings and Working Conditions in Other
F ields_________________________________________________________________
51
Earnings-------------------------------------------------------------------------------------------51
Hours and other working conditions_____________________________________
52
P art IV. Why the Supply of N ursing Care H as Lagged______________
54
Appendix A. Supplementary T ables______________________________________
56
Appendix B. Scope and M ethod of the Study_____________________________
67
Coverage and method of selection_______________________________________
67
Representativeness of returns___________________________________________
67
Tabulation methods___________________________________________
68
Period studied________________________________________________________
68
Annual earnings____________
68
Available information__________________________________________________
59

List of Text Tables
1.
2.
3.
4.
5.
6.
7.
8.
9.

—Age of active and inactive nurses, 1947________________________________
—Experience of active and inactive nurses, 1947--------------------------------------—Amount of nursing education of active and inactive nurses,1947__________
—Veteran status of active and inactive nurses, 1947---------------------------------— Marital status of active and inactive nurses, 1947_______________________
—Percentage distribution of nurses, by monthly earnings, October 1946_____
—Average monthly hours and earnings and average hourly earnings of nurses,
by region, October 1946____________________________________________
—Percentage distribution of nurses, by average hourly earnings, October 1946_
—Percentage distribution of private duty nurses, by hourly rates of pay, October
1946_________________________________________________- ___________
10. —Percentage distribution of nurses, by kind of maintenance provided, October
1946. ________________ ____________________________________ _____—
11. —Usual scheduled hours on duty of nurses on the day shift, October 1946___
12. —Usual daily hours on duty of private duty nurses, October 1946__________
13. —Percentage distribution of nurses, by actual monthly hours on duty, October
1946__________________________________________________ ___________
14. —Monthly hours on call, October 1946_________________________________
15. —Hours on duty of institutional and public health nurses and nurse educators
during on call hours, October 1946---------------------------------------------------16. —Split shifts of institutional nurses and nurse educators, 1947_____________
17. —Overtime work and pay of nurses, 1947________________________________
18.—Late-shift work of nurses, 1947__________________________________________
19. —Pay of nurses for night-shift work, 1947--------------- ---------- ---------------------




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VII

CONTENTS

List of Text Tables—Continued
20. —Advance posting of institutional nurses’ hours, 1947_____________________
21. —Living arrangements of institutional nurses and nurse educators, 1947____
22. —Monthly cash allowances and maintenance provided institutional nurses who
lived outside hospital quarters, 1947_________________________________
23.—Type of room provided institutional nurses living in hospital quarters, 1947-24. —Annual paid vacations of nurses after 1 year’s service, 1947______________
25. —Formal paid sick leave provided nurses after 1 year’s service, 1947_______
26. —Insurance and retirement plans provided nurses, 1947___________________
27. —Hospitalization and medical care provided nurses, 1947__________________
28.—Annual professional expenses of nurses, 1946______________________________
29. —Duties of institutional nurses—Percent of time spent on major groups of duties30. —Opinions of nurses regarding their work, 1947___________________________
31. —Reasons for leaving nursing reported by inactive nurses, 1947____________

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List of Appendix Tables
A -l.—Average monthly earnings of institutional and public health nurses and
nurse educators in selected positions,October 1946_________________
A-2.—Maintenance provided institutional nurses and nurse educators, October
1946____________________
A-3.—Average monthly earnings of institutional and public health nurses and
nurse educators, by age, October 1946_______________________________
A-4.—Average monthly earnings of institutional and public health nurses, by em­
ployer, October 1946_______________________________________________
A-5.—Average monthly earnings of institutional nurses, by hospital size, October
1946______________________________________________________________
A~6.—Average monthly earnings of nurses, by community size, October 1946___
A-7.—Hourly rates of pay of private duty nurses, by community size, October
1946 ____________________
A-8.—Hourly rates of pay of institutional nurses for night-shift work, 1947____
A-9.—Usual scheduled hours on duty of institutional nurses, by shift, October 1946A-10.—Usual scheduled hours on duty of institutional nurses on the day shift, by
employer, October 1946____
A -ll.—Usual scheduled hours on duty of public health nurses, by employer, Oc­
tober 1946________________________________________________
A -12.—Actual monthly hours on duty of institutional nurses, by hospital size, Oc­
tober 1946________________________________________________________
A -13.—Annual paid vacations after 1 year’s service, institutional and public health
nurses, 1947_______________________________________________________
A -l4.—Paid sick leave after 1 year’s service, institutional and public health nurses,
1947 ___________________________________________________________
A -l5.—Insurance and retirement plans provided institutional and public health
nurses, 1947_______________________________________________________
A -16.—Hospitalization and medical care provided institutional and public health
nurses, 1947_______________________________________________________
A -17.—Insurance and retirement plans provided institutional nurses, by size of
hospital, 1947_____________________________________________________
A -18.—Duties of institutional head and general staff nurses—Percent of time spent
on major groups of duties___________________________________________
A -19.—Duties of institutional nurses, by size of hospital—Percent of time spent on
major groups of duties_____________________________________________
A-20.—Number of nurses replying to questionnaire, by region and employment
status___________________________________________________________ -




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The Economic Status of Registered Profes­
sional Nurses, 1946-47
Summary

The Nursing Shortage
The postwar shortage of registered professional
nurses in the United States is primarily due to a
decline in enrollment of student nurses at a time of
rising demand for nursing care and of heavy
losses of graduate nurses because of marriage.
The lag in student enrollment seems to be related
to problems of student training and to the competi­
tion of other fields of employment requiring less
specialized education and thus providing almost
immediate earnings. While workers in some other
jobs earn less than the average nurse, there are
occupations requiring much less training that pro­
vide earnings equal to or above those of nurses.
Moreover, workers in industry generally have
shorter hours and fare better in such provisions as
overtime pay and retirement pensions, although
nurses typically receive more liberal vacations and
sick leave benefits.
The transfer of graduate nurses to other fields is
a minor factor in the nursing shortage, and the
opinions expressed by those nurses who were still
active in their profession indicate that they were
generally satisfied with their work as a whole and
with service to the community. However, many
were dissatisfied with one or more aspects of thenwork. The leading complaints were economic—
lack of retirement pensions and security against
unemployment, rates of pay, and limited oppor­
tunities for promotion. Nurses’ working condi­
tions are summarized in the following pages.

Earnings and Expenses
The average nurse, excluding those living in
hospitals, earned about $175 during the month of
784041°—48-----2




October 1946—about $1 an hour. These earn­
ings were supplemented by an average of about
one meal daily. About one nurse in eight, in­
cluding about one-fifth of the institutional nurses,
lived in hospital quarters; inclusion of the cash
earnings of these nurses would not substantially
affect the over-all average earnings just quoted.
Out of her salary the average nurse spent about
$7 a month—$83 annually—on professional ex­
penses in 1946.
The highest monthly earnings were those of
nurse educators, who averaged $207 in cash in
October 1946. Industrial nurses ranked next,
followed by public health, institutional, and office
nurses. The lowest earnings were those of private
duty nurses, who averaged $153 in the month
studied. Because of variations in hours worked
the rank of these six major fields was different with
respect to average hourly earnings. Institutional
nurses, the largest group in the profession, had the
lowest hourly earnings—87 cents for those pro­
viding their own living quarters—although they
most frequently received meals in addition to
their salary. Industrial nurses stood highest in
hourly earnings, with an average of $1.11.

Hours
The typical scheduled workday in nursing is 8
hours. Hours actually worked during October
1946 averaged about 44 a week; about one nurse
out of four was on duty for 50 hours or more
weekly. Overtime is frequent and typically is not
paid for; where it is paid for, compensation is
generally in the form of time off rather than any
additional cash salary.
The longest hours were reported by institu1

2

SUMMARY

shifts and had to be on call for some hours beyond
their time on duty. Night work was more com­
mon in this than in any other field except private
duty. Vacation and sick leave provisions were
relatively liberal.
2. Nurse educators received the highest monthly
earnings of any branch of the profession and had
the longest vacations. Although they worked
slightly shorter hours than did institutional
nurses (with whom they shared many working
conditions) their workweek exceeded those in
other branches of the profession. While most
nurse educators lived outside, they were required
to live in hospital quarters more frequently than
any other nurses.
3. Because part-time work of some private duty
nurses reduced their average hours below those in
any other branch, their average monthly earnings
in October 1946 were the lowest in any branch of
nursing. Their typical hourly rate was, however,
exceeded only by the hourly earnings of public
health and industrial nurses. Frequently they
Vacations, Sick Leave, and Insurance
received one meal daily in addition to their cash
Except for those on private duty, almost all salaries. Since private duty nurses continually
nurses received paid vacations and four out of change employers and are not covered by the
five were covered by formal sick leave plans. Social Security Act, they do not benefit from either
Vacations were typically 2 weeks long, although private or publicly operated retirement pension
4-week vacations were frequent in institutional plans, vacation and sick leave plans, or medical
and public health work and in nursing education. care arrangements.
Outside the industrial and office fields, most
4. Of the six branches of nursing, public health
nurses were not covered by retirement pension nursing ranks second highest in terms of hourly
plans. Nor did nurses typically receive free earnings and third in monthly earnings; these
hospitalization, medical care, or insurance, al­ earnings are seldom supplemented by meals or
though these benefits were more common in in­ laundry of uniforms. Monthly hours on duty are
stitutional work than in other branches of the shorter than in any other branch of nursing except
profession.
private duty. Retirement provisions are relatively
more common than in most other branches of
Variations in Working Conditions Among nursing, although less than half the public health
nurses reported such arrangements. Sick leave
Nursing Fields
was widespread; but public health nurses fared
Working conditions varied appreciably among relatively poorly in provisions for medical care and
hospitalization.
the six major fields of nursing:
1. Institutional nurses had the lowest hourly 5. Industrial nurses had the highest hourly
pay and the longest hours on duty, but because earnings. However, their monthly pay was ex­
of their relatively long hours their monthly ceeded by that of nurse educators since they worked
earnings were above those of both private duty comparatively short hours. Unlike other nurses,
and office nurses. Allowance for meals received they are protected by both old-age and unemploy­
would about equalize the monthly but not the ment compensation provisions of the Social Se­
hourly pay of institutional and public health curity Act. Overtime pay and premium pay for
nurses. A substantial minority worked split night work were most common in this field. To­

tional nurses, who were on duty an average of
48 hours a week in October 1946, and the shortest
hours were those of private duty nurses, who
averaged 39 hours weekly. In all fields except
institutional work scheduled workweeks of 44
hours or less are typical, and in public health
work weekly schedules of 40 hours or less are
most common.
In addition to her hours on duty, about one
hospital nurse in four was required to be on call,
and a corresponding proportion worked split shifts.
For those subject to call, time on call amounted
to roughly 35 hours a month beyond hours on
duty in October 1946.
Most nurses normally work only on the day
shift; those on duty at night usually receive the
same hourly rate as for day work. Rotation
between early and late shifts is slightly more
common than continued employment on late
shifts.




3

SUMMARY

gether with office nurses, they received relatively
short vacations.
6. Office nurses, monthly pay was the lowest in
October 1946 of any field except private duty, and
their hourly pay was the lowest except for institu­
tional nurses. Working hours in this field were
exceeded by those of institutional nurses and nurse
educators; and office nurses were seldom paid in
any way for overtime. Formal sick leave arrange­
ments were less frequent than for other nurses.

Regional Variations in Working Conditions
On a regional basis, the best salaries and working
conditions, particularly in institutional and private
duty work, were found on the Pacific Coast. How­
ever, vacations were shorter in these States than
elsewhere.
New England ranked lowest in terms of salaries.
Split shifts and hours on call were also relatively
common in New England, and the proportion of
time spent on nonprofessional duties was higher in
this region and in the Middle Atlantic States than
in the rest of the country. In contrast, New




England and Middle Atlantic nurses reported the
longest vacations.
Except for New England and the Pacific States,
generalization with respect to the relative position
of each region is difficult. No one region con­
sistently had the longest hours in all fields in Oc­
tober 1946 (although the West Middle and South­
west tended to have relatively long hours).

Duties
How was the time of the limited number of pro­
fessional nurses who were active in their profession
allocated among different duties? About 30 per­
cent of the “ average” hospital nurse’s time was
spent in making beds, answering fights, carrying
trays, bathing and feeding patients, giving back
rubs, taking patients to appointments, checking
linens and household supplies, and on clerical work
(other than nurses’ notes). About half of her time
was spent on preparing and giving medication,
changing dressings, giving aseptic treatments and
similar duties, assisting in operations and deliveries,
and in supervising other nurses and nonprofessional
help. The rest of the day was devoted to a
variety of other duties.

Introduction
In 1946 it was estimated that the United States
needed 360,000 registered professional nurses—
roughly 100,000 or two-fifths more than were
actively engaged in their profession.1 This figure
is based on current standards of medical care,
rather than on higher standards that might be
considered desirable for the Nation’s health, and
on the present division of functions between pro­
fessional nurses and other members of medical
staffs. Additional nurses were needed in all or
practically all fields of the profession.
What has caused this acute shortage of nursing
care? Both demand and supply are involved in
the nursing shortage. The demand for nursing
service has increased sharply, and the supply of
nurses has failed to keep pace. Among develop­
ments contributing to the rise in demand are the
rise in the proportion of older persons in the popu­
lation; the war and postwar increase in the birth
rate; the needs of disabled veterans; and the greater
resort to hospital care resulting from higher medi­
cal standards, higher incomes, and the spread of
prepayment plans for medical care.
Meeting the demand for nursing care involves
complex problems since this care is largely pro­
vided by graduate nurses who have completed
relatively long periods of specialized training.
Maintaining or increasing the supply thus involves
the attraction of students who are willing to serve
an extended period of time without salary and in
many cases to pay tuition for their education.
To a considerable extent, too, the supply of nursing
care depends on the services rendered by these
student nurses in the course of their training. It
is of utmost importance, therefore, to attract newi
i Estimate of total need is that of the Committee on Statistical Research
of the National Nursing Council (Facts about Nursing, 1946, p. 8). The
National Nursing Council estimated the shortage at around 40,000 on the
assumption that a large group of nurses available for work would return.
The 100,000 figure was obtained merely by subtracting the total nurses actu­
ally employed in 1946 (about 260,000) from the number needed. Of the
inactive nurses studied by the Bureau of Labor Statistics, only a small
proportion indicated plans to return to their profession, at least in the near
future.

4




trainees in increasing numbers when demands for
nursing care are on the increase.
A relatively high rate of attrition is expected in
most occupations in which women predominate.
In those pursuits where little training is required
such attrition is not serious; in fact it may be an
advantage to a particular industry in that entrance
into the occupation can be more easily geared to
changing employment opportunities. To nursing,
however, it means loss of trained personnel that is
not easily replaced. In times of unemployment,
limited job opportunities for women and the op­
portunity to be of service to the community serve
as sufficient incentives to new entrants. How­
ever, with current high levels of employment, it
is probable that the shortage of nurses is at least
partly the result of the kinds of incomes and
working conditions afforded to members of the
profession. Consequently, the economic oppor­
tunities available to nurses have become a subject
of general public interest.
The present study was intended to throw fight
on the supply side of the nursing shortage, with
emphasis on social and economic factors. This
emphasis does not imply a lack of recognition of
noneconomic motives that comprise job satisfac­
tion. Clearly an interest in service to the ill is
an important motivation for entering and remain­
ing in nursing. The economic and social condi­
tions in nursing as compared with other fields,
however, cannot be ignored as factors in attracting
potential nurses and in the continuance and satis­
faction of graduate nurses in their profession.
The study attempts to answer the following
questions. Why do nurses leave their profession?
What are the salaries, hours, and working condi­
tions in nursing today? How do they compare
with those in other fields? How is nurses’ work­
ing time allocated among their duties? What are
the personal characteristics of nurses? What do
nurses think of their profession? How do these
facts and opinions explain the nursing shortage?

Part I. Active Nurses
Chapter 1. Characteristics o f the Nursing Profession
What are the major fields and positions in the
nursing profession? Where and by whom are
nurses employed? What are the personal char­
acteristics of the approximately 250,000 registered
nurses who are active in their profession today—
how old are they—are they married or single—
how much education and experience have they
had in their profession? Answers to some of these
questions are provided by the study summarized
here; information from other sources is briefly
presented to round out the picture.1

Fields of Nursing
Registered professional nurses can be classified
in six fields. (In addition, there are other nurses
whose duties either do not fit or cut across these
specific fields.):
1. Institutional. Includes work in govern­
mental and nongovernmental hospitals, clinics, and
other institutions.
2. Private duty. Characterized by employment
of nurses by individual patients rather than by a
hospital or other institution to care for or contrib­
ute to the care of a group of patients.2
3. Public health. Includes public health nurses
engaged primarily in preventive work and health
education and in part-time home care of the ill;
includes school and other nurses employed by
municipal and other Government health agencies
as well as those working for such nongovernmental
organizations as visiting nurse and tuberculosis
associations and the Red Cross; excludes those in
Government hospitals.
i Unless indicated to the contrary, information presented here is based on
the Bureau’s study rather than on other sources of data. Characteristics of
inactive nurses are discussed in pt. II, ch. 2.
* Sometimes private duty nurses are employed for “group nursing” by
two at three patients.




4. Industrial. Includes nurses employed by
manufacturing or nonmanufacturing establish­
ments for emergency or preventive nursing care of
their employees.
5. Office, Includes nurses who assist doctors
and dentists in their office work.
6. Full-time nursing education. Includes both
teachers of student nurses and those giving ad­
vanced nursing instruction. (Because they teach
in training schools closely associated with hospi­
tals, many of the working conditions of nurse
educators are closely related to those of institu­
tional nurses. They are, however, considered as
a separate group in this report.)
Numerical Importance

The number in each field can be briefly sum­
marized:
Field

Estimated employment ofrsgis*
tered professional nurses, 1946
Number
Percent

All fields____________________ _ 250,000
Institutional_________________ _ i 140, 000
Private duty________ ________ . * 59, 000
Public health________________ _ * 21, 000
4 9, 000
Industrial___________________
Office. _____________________ _ 6 10, 000
« 6, 000
Full-time nursing education___
5, 000
Other____ __________________

100
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2
2

1Journal of the American Medical Association, April 12, 1947, p. 1076,
reports 146,602, including nurse educators.
2 American Nurses’ Association estimate, in Facts about Nursing, 1946
(issued by Nursing Information Bureau, American Nurses’ Association), p.
49.
«Total Number of Nurses Employed for Public Health Work.......... 1947,
U. S. Public Health Service.
4 Estimated by Division of Industrial Hygiene, U. S. Public Health Ser­
vice, in Facts about Nursing, 1946, p. 53. (Mimeographed.)
* May be as high as 15,000. Bureau of Labor Statistics estimate, based
on questionnaires returned in present study.
• Estimated. Journal of the American Medical Association, April 12,
1947, p. 1076, reports 4,174 full-time instructors.

5

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

6

Positions
The fields of institutional and public health
work and nursing education encompass a variety
of positions, differing in duties and responsibilities.3
The numerically most important positions in in­
stitutional work, including nursing education, and
the number of nurses in each are listed below,
roughly in descending order of responsibility:
Estimated number
of nurses, 19461

Positions

Directors and assistant directors of nursing____ 8, 423
Supervisors and assistant supervisors........... .......... 18, 295
Head and assistant head nurses_______________ 25, 555
Full-time instructors_________________________ 4, 174
General staff nurses__________________________ 84, 792
1Journal of the American Medical Association, April 12, 1947, p. 1076.
Some nurses also are administrators of hospitals.

In public health nursing, several distinct posi­
tions are recognized: administrators and as­
sistant administrators, consultants, supervisors
and assistant supervisors, staff nurses, and school
nurses. Of these, the numerically largest groups
are staff and school nurses.

Employers
Governmental units (Federal, State, county,
and city), nongovernmental hospitals and clinics,
and individual members of the community who
require special nursing are the leading employers
of nurses. Business establishments and doctors
and dentists employ most of the country’s re­
maining nurses.
Although about three-fourths of all hospital
beds are in governmental institutions, they em­
ploy a smaller proportion of the institutional
nurses; many of the governmental hospitals are
mental institutions with a low ratio of nurses to
patients. Most public health nurses work for
State, county, and municipal agencies. Except
for a comparatively small group of Federal public
health nurses, the others in this field work for
such nongovernmental agencies as visiting nurse
and tuberculosis associations.

Geographic Distribution
The nursing population is distributed regionally
in rough proportion to total population, except
•Nursing positions differing in responsibility are also found in some of
the largest industrial establishments, but the number of industrial nurses in
supervisory positions is small.




that the Southern sections of the country have
distinctly less per capita nursing care. Whereas
the Southeast and Southwest have one-fourth of
the country’s population, they together have
roughly one-eighth of the registered professional
nurses. The four regions (Great Lakes, Pacific,
New England, and Middle Atlantic) that have
three out of every four nurses account for only
about three-fifths of the population.4 (Half the
registered professional nurses live in the Middle
Atlantic and Great Lakes regions.) Available
data indicate that about one-third are in com­
munities of at least a quarter of a million popula­
tion, which, of course, provide much of the medical
care for surrounding areas as well as for their own
inhabitants.

Age, Experience, and Education
The average nurse still active in her profession
and particpating in the study is 34 years of age and
has had 9 years of experience in addition to her basic
nursing education and any graduate study (tables
1 and 2).5 About one in four is under 27 years of
age, and a corresponding proportion is at least
43 years old. The age of the professional nurses
group is about the same as that of all employed
women.6
About 3 out of 10 nurses had taken some gradu­
ate training beyond their basic nursing education.
Among these, the amount and kind of advanced
training varied considerably; a substantial group
had had a combination of advanced clinical and
college courses in nursing (table 3). Among
participants in the study, there was no marked
concentration of nurses who received their basic
nursing education in any one size of hospital.
Few trained in hospitals of less than 50 beds but
about 7 percent received their clinical experience
in hospitals with 50 but less than 100 beds.7
4 The States included in each region are listed in table 7, footnote 2.
8 Except where indicated to the contrary, averages used in this report are
medians (the values below and above which half of the replies fall). Use of
such an average minimizes the influence of inaccuracies in reporting such
items as earnings, expenses, and actual hours of work, which are likely to
occur in replies to a mail questionnaire.
• The average age of all nurses, including students, is reported as 29 years
in the 1940 census. Exclusion of students would probably raise the average
to between 33 and 34 years. See U. S. Bureau of the Census, Sixteenth
Census of the United States, 1940: Population, vol. Ill, pt. I, p. 100; and
Monthly Labor Review, December 1947, p. 669.
7 Participants in the survey were asked to include the number of beds in
affiliated institutions when reporting the size of hospital in which they did
their clinical work.

PART I.
T a b l e 1.—Age

7

ACTIVE NURSES

of active and inactive nurses, 1947

Percent of active nurses
Age

Percent of inactive nurses

Nurse
All* Institu­ Private Public Indus­ Office educa­
tional duty health trial
tors

Not employed
Em­
Intend­ Notin­ Unable
All ployed
outside
ing to tending work,
nursing A1P House­ return to re­ toor re­
wives to turn to
nursing nursing tired

Under 21 years. ................................... 0.1
0.1
0.1
21-22 years. ..........................................
4.8
7.6
3.0
23-24 years. ......................................
10.2 13.2
8.2
25-26 years........ .................................... 10.0 12.1
8.8
27-29 years............................................ 10.5 11.2
9.4
30-34 years. .......................................... 15.3 14.7 15.0
35-39 years............................................ 15.3 13.9 14.6
40-44 years. .......................................... 11.4
9.8 11.2
45-49 years........................................... 8.2
6.6
9.0
50-59 years. .............................. ............ 11.0
8.7 15.3
2.1
60 years and over.................................. 3.2
5.4
Total........................................... 100.0 100.0 100.0
Number of replies to question............ 12,536 5,425 2,827
32
34
Average * age........................................
37

0.1
1.2
5.1
4.3
7.7
14.4
18.9
15.5
11.8
16.4
4.6
100.0
1,338
39

2.2
6.3
7.6
11.6
17.1
18.7
14.6
9.9
10.6
1.4
100.0

m"
36

0.3
4.2
12.2
14.0
13.7
20.6
16.0
9.4
4.8
4.0
.8
100.0
1,029
31

(3)
1.8
2.0
7.6
6.9
9.0 11.5
11.2 15.3
15.7 24.1
17.6 18.0
11.9
9.0
12.4
4.9
8.8
5.6
3.8
2.9
100.0 100.0
445 9,046
36
33

(3)
1.8 (2)
1.6
1.0
4.4
6.6
7.1
5.7 11.9 12.1
9.3 15.8 16.3
15.7 24.9 26.6
18.1 18.0 19.1
15.9
8.4
8.5
4.4
4.2
11.7
12.4
5.1
4.1
2.6
5.8
.9
100.0 100.0 100.0
635 8,411 7,157
39
33
33

5.3
2.4
17.1 10.9
16.6 15.8
15.1 22.4
18.9 20.0
12.3 16.4
8.1
6.7
2.8
2.4
2.4
2.3
1.5
.6
100.0 100.0
165
397
29
27

1.7
3.4
4.3
7.9
9.4
9.0
7.9
8.1
19.4
28.9
100.0
469
49

1Includes data for categories not shown separately.
3Less than 0.05 of 1 percent.
3Median.
T a b l e 2. —Experience of active and inactive nurses,
Percent of active nurses
Amount of experience

1.4
1.6
4.8 14.2
10.4 17.4
22.3 27.3
21.9 18.3
16.5 11.4
11.7
6.5
11.0
3.3
100.0 100.0
840 1,031
13
8

deludes data for categories not shown separately.

Institutional and office nurses were the youngest
on the average and had the least experience in their
profession while public health nurses were the
oldest and most experienced. The average age of
public health nurses was about 2 or 3 years above
that of nurse educators and industrial and private
duty nurses, and about 8 years above that of insti­
tutional and office nurses. The variation in
amount of experience was slightly narrower than
that in age.




Percent of inactive nurses

Nurse
A ll1 Institu­ Private Public Indus­ Office educa­
tional duty health trial
tors

2.9
Less than 1 year...................................
2.1
1.6
0.8
1-2 years.................................-............. 12.8 17.9 10.4
5.4
7.8
3-4 years.................................. .1.......... 13.7 15.7 13.4
5-9 years................................................ 21.6 21.4 21.3 18.0
10-14 years.............................................. 17.0 15.4 16.6 18.9
15-19 years______________________ 13.9 12.4 13.9 17.7
9.9 12.4
7.1
20-24 years............................................ 8.9
7.2 12.9 19.0
25 years or more.................................... 10.0
Total............................................ 100.0 100.0 100.0 100.0
Number of replies to question............ 12,514 5,412 2,812 1,334
9
8
11
Average2years, all nurses...................
14

1947

Not employed
Em­
Intend­ Not in­ Unable
All ployed
outside
ing to tending work,
nursing Ain House­ return to re­ toor re­
wives to turn to
nursing nursing tired

7.3
1.6
9.1 17.9
10.2 22.7
24.2 27.8
18.9 13.4
5.5
17.1
2.3
8.7
10.2
3.1
100.0 100.0
449 8,983
11
5

6.1
7.4
8.1
7.5 18.7 19.6
15.8 23.1 24.3
23.8 28.1 28.6
18.7 13.0 12.8
14.2
4.8
4.2
2.1
5.6
1.6
8.3
2.8
.8
100.0 100.0 100.0
627 8,356 7,126
5
9
4
!

3.5
21.4
21.4
26.3
13.6
9.0
2.5
2.3
100.0
398
6

1.8
15.2
21.8
32.1
18.2
6.7
3.0
1.2
100.0
165
7

2.6
6.7
9.3
21.3
14.0
8.0
7.8
30.3
100.0
450
14

3 Median.

Public health nurses and nurse educators dif­
fered sharply from others in their profession in
amount of nursing education. In these fields
where the greatest emphasis is placed on educa­
tional requirements, three out of five nurses had
some graduate work, compared with not more than
one out of four in the other branches of nursing.
Moreover, of the nurse educators and public health
nurses who had taken no graduate work, a com­
paratively large proportion had received their

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

8

T able 3.—Amount of nursing education of active and inactive nurses, 1947
Percent of active nurses
Amount of education

Basic nursing education only..............
24-35 months..................................
36 months only_______________
4- or 5-year undergraduate course.
Graduate nursing education...............
Graduate college work:
Less than 30 semester hours. _
30 but less than 60 semester
hours__________________
60 or more semester hours.......
Clinical graduate work:
Less than 3 months___ ____
3 but less than 6 months____
6 but less than 9 months..........
9 months or more..................
Other graduate work 2................
Total..........................................
Number of replies to question.............

Nurse
A1U Institu­ Private Public Indus­ Office educa­
tional duty health trial
tors
70.3
3.8
62.1
4.4
29.7
5.3
1.9
2.2
1.3
3.5
3.3
1.7
10.5
100.0
12,008

73.6
3.6
66.1
3.9
26.4
4.0
1.4
1.3
1.5
4.4
3.8
1.3
8.7
100.0
5,122

82.0
4.3
75.1
2.6
18.0
2.1
.4
.9
.7
2.8
2.4
1.4
7.3
100.0
2,766

41.5
3.6
29.5
8.4
58.5
15.1
7.6
7.3
1.4
2.5
2.6
1.9
20.1
100.0
1.255 |

75.0
3.9
69.4
1.7
25.0
5.2
1.0
1.6
1.8
3.0
3.2
1.0
8.2
100.0
821

1 Includes data for categories not shown separately.

basic education as part of a 4- or 5-year college
course. Among institutional, private duty, and
office nurses who had undertaken advanced nurs­
ing study, clinical work was relatively more com­
mon than collegiate courses.
Among hospital nurses, those in the more re­
sponsible positions were older and had the most
experience and education.8 There appeared to be
no tendency for nurses who had received their
education in hospitals of a certain size to obtain
supervisory positions more frequently than other
nurses. Average experience varied from 4 years
for assistant head nurses to 18 or 19 years for
hospital administrators and directors or assistant
directors of nursing. Four out of five general staff
nurses reported only a basic nursing education,
compared with less than half of the directors of
nurses and two-thirds of the hospital administra­
tors and supervisors. Moreover, of those in the
latter two positions who had only a basic nursing
education, a larger proportion had obtained this
training as part of a 4- or 5-year course leading to a
college degree.
8The comparatively small group classified as assistant head nurses was
even younger and had less experience than staff nurses; the average age in
the two positions being 26 and 29, respectively.




Percent of inactive nurses

79.6
3.7
71.9
4.0
20.4
2.8
.6
.9
1.5
3.5
3.0
1.3
6.8
100.0
1,014

Not employed
Em­
Intend­ Notin­ Unable
All ployed
ing to tending work,
outside
nursing All i House­ return to re­ toor re­
wives to turn to
nursing nursing tired

30.6 78.0
3.9
1.2
11.4 70.4
3.7
18.0
69.4 22.0
3.2
17.5
1.3
5.7
1.2
11.4
.7
1.0
2.1
2.8
1.9
2.7
3.3
1.5
26.8
8.3
100.0 100.0
422 8,898

67.2 79.0
4.5
3.8
58.1 71.6
3.6
4.6
32.8 21.0
3.2
2.6
1.4
.3
2.1
1.1
1.3
.9
2.8
3.0
2.6
4.0
1.4
2.7
16.8
7.6
100.0 100.0
624 8,274

81.8
3.6
74.6
3.6
18.2
2.7
.8
.7
.9
2.9
2.2
1.3
6.7
100.0
7,062

46.2 67.1
1.6
1.8
38.3 61.6
6.3
3.7
53.8 32.9
10.9
4.9
9.6
3.7
4.9
7.0
1.2
1.0
.6
3.1
4.7 ' 3.0
1.6
1.8
15.9 12.8
100.0 100.0
164
384

72.2
10.3
60.3
1.6
27.8
3.6
1.6
.7
1.3
2.5
4.7
2.0
11.4
100.0
446

2Includes combinations of college and clinical work.

For two positions—general staff and head
nurses—an analysis was made of nursing education
by region. This indicates that a larger proportion
of nurses in both positions in the Southeast and
Southwest than in other regions were trained in
small hospitals (less than 100 beds). A compara­
tively high proportion of the Middle Atlantic
nurses were graduates of schools affiliated with
hospitals containing 500 or more beds.

Other Characteristics
Almost all registered professional nurses are
white women. According to the census, about 2
percent are Negro women and about the same
proportion are white men. In its high proportion
of women members, nursing contrasts with other
professional groups in the United States; even in
teaching, where women are more numerous than
in most professions, roughly one in four is a man.9*
•
Most of the small number of Negro nurses are in
institutional and public health work, while men
are largely employed as institutional nurses,
frequently in psychiatric work.
• U. S. Bureau of the Census, Sixteenth Census of the United States, 1940:
Population, vol. Ill, pt. 1, pp. 49, 88, 90, 107, and 111.

PART I.

9

ACTIVE NURSES

Most professional nurses are single and without
At the peak of enrollment in the armed services
in World War II, about one nurse in four was a dependents. Of those who participated in the
member of the Aimy or Navy Nurse Corps.10 survey about two out of five were married; of this
group one in four had dependents (table 5).
T able 4.— Veteran status of active and inactive nurses, 1947 According to the 1940 census only one out of five
nurses, as compared to about one-third of all
Percent who
All replies
employed women, was married11 although oppor­
were—
Employment status
tunities for employment of married nurses have
Num­ Percent Veterans Non­
since increased. The proportion of married women
ber
veterans
in 1947 was not much lower among active nurses
All active nurses1_________ ______ 12,578 100.0
18.6
81.4
Institutional......... ......................... 5,440 100.0
than among those who had left nursing for other
21.5
78.5
Private duty................................... 2,830 100.0
14.4
85.6
fields of employment.
Public health.................................. 1,341 100.0
81.2
18.8
Industrial...................................... .
843 100.0
18.5
81.5
Since private duty permits the greatest flexi­
Office................................................ 1,033 100.0
18.0
82.0
Nurse educators............................
449 100.0
9.3
90.7
bility of hours and part-time employment, pro­
All inactive nurses1.............................. 9,094 100.0
84.2
15.8
portionately more married nurses are in this field
Employed outside nursing...........
637 100.0
82.3
17.7
Not employed1.............................. 8,223 100.0
15.4
84.6
than in other fields of nursing; of those who are
Housewives.............................. 7,176 . 100.0
11.3
88.7
Intending to return to nurs­
married, a larger proportion of private duty
ing..........................................
398 100.0
59.5
4a 5
Not intending to return to
nurses have dependents. Seventeen percent of
nursing.................................
165 100.0
64.2
35.8
Unable to work, or retired...
484 100.0
23.6
76.4
the nurses in this field who participated in the
study were married and had children or other
i Includes data for categories not shown separately.
dependents; another 35 percent had husbands but
Roughly one out of six nurses participating in the no dependents. The industrial and office fields
present study was a veteran of World War I or II came next in the proportion of married nurses.
and an additional small group of veterans were In all branches except private duty no more than
taking advanced nursing training. The proportion 1 in 10 was married and had dependents and from
of veterans was smaller in private duty and educa­ a fourth to a third were married but did not have
8
1
tion than in other fields of nursing (table 4); it is dependents.12*
possible that veterans planning to enter the latter
11 U. S. Bureau of the Census, Sixteenth Census of the United States, 1940:
Population,
pt. Estimate based on
field were themselves taking advanced education from census vol. Ill, AlsoI.excluded areis those whoexclusion of student nurses
data.
are divorced, separated,
at the time of the survey.
or widowed.
10 Facts about Nursing, 1946, Nursing Information Bureau, American
Nurses' Association, pp. 46-47.

In 1946 about 44 percent of all women in the labor force were married
(Monthly Labor Review, December 1946, p. 670).
18 Only 1 in 10 nurse educators was married and had no dependents.

T able 5.—Marital status of active and inactive nurses, 1947
Percent of active nurses
Marital status
Single, with 1 or more dependents...........................
Single, with no dependents.......................................
Widowed, divorced, or separated, with 1 or more
dependents...............................................................
Widowed, divorced, or separated, with no de­
pendents................................................................. Married, with 1 or more dependents......................
Married, with no dependents................... ...............
Total______________________ __________
Number of replies to question.................. ...............

A ll1
9.7
40.4
5.3
5.6
11.7
27.3
100.0
12,499

Institu­ Private
tional
duty
9.8
45.6
5.1
5.1
10.4
24.0
100.0
5,403

Public
health

7.9
28.9
4.5
6.4
17.4
34.9
100.0
2,814

i Indudes data for those employed in nursing; outside fields presented separately.
784041°—48----3




13.1
41.8
7.3
4.2
10.2
23.4
100.0
1,329

Indus­
trial
9.3
35.1
7.4
8.6
9.6
30.0
100.0
840~

Percent of inactive nurses
Nurse
Office educators
8.4
37.2
6.0
5.0
10.2
33.2
100.0
1,030

12.9.
63.7
3.4
3.4
4.7
11.9
100.0
447~

All
1.7
8.6
1.6
1.9
42.5
43.7
100.0
8,973

Employed Not em­
outside
nursing ployed
7.9
31.0
7.7
7.9
19.6
25.9
100.0
633~

1.3
6.9
1.2
1.5
44.2
44.9
100.0
8,340

Chapter 2. Earnings and Hours, October 1946 1
3

Earnings averaged $41 a week and $1 an hour
in October 1946 for nurses living outside hospital
quarters. These earnings were supplemented by
an average of about one meal a day. The typical
daily work schedule was 8 hours. Weekly hours
varied widely among the different branches of
nursing, 48-hour schedules being most common
in institutional work and 40- or 44-hour schedules
being predominant in other fields. Actual hours
on duty varied from 39 a week for private duty
to 48 for institutional nurses; for all fields con­
sidered together, the average was 44 hours a
week although one in four nurses worked at least
50 hours weekly in October 1946.
This is a brief picture of nurses7 horn’s and
earnings in October 1946. However, the hours
and earnings patterns are actually complex: thus,
many nurses receive varying amounts of main­
tenance in addition to their cash salary and in
some fields there are substantial numbers whose
work restricts their freedom beyond actual hours
on duty. Detail regarding these qualifications
and variations among as well as within nursing
fields is provided in the following pages.

Earnings and Supplementary Maintenance
Monthly Earnings

The monthly cash earnings of registered pro­
fessional muses required to provide their own
living quarters averaged $176 a month (or $41 a
week) in October 1946.14 About one in four
i* All earnings include cash paid in lieu of room and/or other maintenance,
but exclude the cash equivalent of maintenance provided by employers.
N o effort has been made to reflect salary increases since October 1946. Hours
on duty exclude meal periods.
14 Earnings of those occupying hospital quarters are discussed later. In­
clusion of earnings of this group, which is relatively small, would not sub­
stantially affect the average earnings mentioned above: inclusion of their
cash earnings would reduce the average about $1; the average would be raised
$1 to $2 a month if the average allowance for maintenance reported by those
living out were used as the value of maintenance provided those living in
and added to their cash earnings.
10




earned less than $145 and a corresponding pro­
portion received at least $205 a month (see table
6 and chart 1).
Earnings varied among the different branches
of the profession from an average of $153 for
private duty nurses to $207 for nurse educators
not residing in hospital quarters (table 7). Aver­
age cash earnings of office nurses ($167 a month
or $39 a week) and institutional nurses occupying
their own quarters ($172) ranked above private
duty monthly earnings but were topped by pay
of public health and industrial nurses ($184 and
$196, respectively). The pay of industrial nurses
was almost equal to that of the average factory
worker at that time.
Monthly earnings varied more among individual
private duty nurses than among members of any
other field, primarily because of differences in
hours worked. Thus, one in four members of
this branch of nursing earned less than $95 and
the same proportion earned at least $200. At
the time of the study, the variation in time worked
was apparently traceable primarily to personal
choice rather than to lack of work. In all other
fields earnings of half of the nurses varied by
about $60 or less. About 1 nurse educator in 10
reported monthly earnings of at least $300.
The spread in earnings within the institutional,
education, and public health fields was traceable
to different earnings for different positions as well
as to varying salaries for the same work. Among
the individual hospital positions for which suffici­
ent data were obtained, cash pay for nonresident
nurses varied from $161 for general staff nurses,
the numerically largest group in this field, to $239
for directors or assistant directors of nurses. The
salaries of the latter group were exceeded to an
undetermined degree by those of hospital admin­
istrators. In the public health field, staff and
school nurses averaged $177 and $182, respectively.

PART I.
T

a b le

6.

ACTIVE NURSES

11

— Percentage distribution of nurses, by monthly earnings 1, October 1946

Monthly earnings
Under $95_ _ ____
_ _____ _ . _
$95 and under $105....................................................
$105 and under $115.......................................................
$115 and under $125.......................................................
$125 and under $135.......................................................
$135 and under $145.......................................................
$145 and under $155.......................................................
$155 and under $165.......................................................
$165 and under $175.......................................................
$175 and under $185.......................................................
$185 and under $195.......................................................
$195 and under $205.............................................. ........
$205 and under $215.......................................................
$215 and under $225.......................................................
$225 and under $235.......................................................
$235 and under $245.......................................................
$245 and under $255.......................................................
$255 and under $265.......................................................
$265 and under $275.......................................................
$275 and under $285.......................................................
$285 and under $295.......................................................
$295 and under $305......................................................
$305 and over................... ..............................................
Total......................................................................
Number of replies to question......................................
Average8monthly earnings of all nurses................

Nurses living outside hospital
Afi fields8 Institu­ Private
tional
duty
9.3
2.4
1.6
2.7
3.5
5.9
8.5
8.6
6.9
10.5
5.9
10.3
4.2
5.1
3.2
2.4
3.2

5.8
2.1
1.2
3.3
4.2
7.5
9.7
10.9
7.3
10.9
6.7
9.4
4.4
5.4
3.1
2.1
1.7

1.2
.4
.8
1.8
100.0
9,182
$176

.3
.7
1.3
100.0
3,443
$172

.9
.7

.6
.6
.8

1Includes cash paid in lieu of maintenance but excludes the cash equivalent of maintenance provided by employers.
3Includes data for nurses employed outside fields shown separately.

Public
health

25.2
4.9
3.4
2.9
3.2
5.2
6.6
5.5
5.5
6.4
4.0
7.1
2.9
4.5
1.5
2.2
4.6
.3
.5
1.2
.3
.7
1.4
100.0
2,155
$153

2.3
.6
.6
1.1
2.9
4.3
7.7
9.8
8.8
13.4
7.6
10.2
5.7
6.7
3.6
2.7
2.7
2.0
1.0
1.6
.7
.9

3.1
100.0
1,243
$184

Indus­
trial
2.5
.1
.6
.7
1.7
2.5
4.7
7.5
8.8
12.0
8.1
14.5
7.3
5.5
6.7
3.8
4.5
2.1
1.1
1.8
.7
1.1
1.7
100.0
876~
$196

Nurses Uving in hospital
Nurse
Nurse
Office educators A n fields* Institu­ educators
tional
3.6
2.8
1.5
4.2
5.3
7.8
14.3
9.1
5.7
13.9
3.3
14.5
1.2
2.5
3.4
1.3
2.7
.7
.2
.4
.8
.8
100.0
914~
$167

0.4
.4
.4
.4
1.9
1.6
3.1
3.9
6.6
8.9
4.7
16.4
6.2
7.0
5.4
4.7
7.4
1.6
3.1
3.9
1.9
2.3
7.8
100.0
25f
$207

2.8
2.2
2.2
5.9
7.3
10.0
11.4
6.8
4.7
8.9
5.0
8.3
3.1
4.0
4.0
2.8
2.0
1.0
.5
2.2
.9
1.3
2.7
100.0
1,114
$168

2.9
2.1
2.7
6.4
8.1
11.1
13.3
7.0
5.0
8.1
4.2
6.9
2.2
4.3
3.3
2.7
1.8
1.0
.7
2.0
g
1.0
2.4
100.0
899”
$160

24
3.3
4.1
100.0
122
$194

Private duty, public health, industrial, and office nurses live outside hospital quarters.
* Median.

T g ra s B B K i mmEmasLsmvxmL

CHART l

14rMonthly Earnings Of Professional Nurses
Living Outside Hospital Quarters

i2 - October 1946




0.8
1.6
2.4
5.7
3.3
4.9
5.7
17.9
8.9
14.6
5.7
4.1
7.3
4.1
2.4
.8

OOLLARS PER MONTH

12

O VER

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

12

T able 7.—Average monthly hours and earnings and average hourly earnings 1 of nurses, by region,2 October 1946
Field, position, and living arrangements

Institutional:
All positions ..........................................................................
Living in hospital quarters
_____
Living outside hospital quarters
_
General staff nurses i* T____T______ __________________
3.
Living in hospital quarters
Living outside hospital quarters
. _ ___
Private duty * ___
Public health _ _
Industrial____ _ _
Office.
_ _
Nurse educators. _
___ _ __ ___________ _

Num­ United New Mid­ Border South­ Great Mid­ South­ Moun­
ber of
Eng­ dle
Pacific
dle
replies States land Atlan­ States east Lakes West west tain
tic
Average monthly hours
207
213
195
202
207
202
167
175
177
185
202

4,415
821
3,170
1,851
276
1,410
2,040
1,088
701
829
380

208
214
193
205
206
206
167
178
176
179
207

208
212
196
207
209
207
172
169
174
174
196

209
217
203
198
194
202
166
173
175
186
212

210
212
203
203
213
194
182
180
174
193
206

207
210
192
202
208
201
165
178
178
184
202

212
223
205
206
203
206
172
184
177
194
196

211
210
206
200
188
205
160
184
177
199
202

207
211
194
194
204
194
159
171
183
183
204

191
206
185
187
194
186
158
172
177
184
194

$168
177
190
164
00
182

$198
177
183
169
00
182

168
157
170
154
163
174
170
163
197
168
00
195

00
163
177
151
153
190
200
183
170
171
m
(5)

$202
204
204
207
224
221
197
198
197
201
162
221
224
218
230
197
00258

$0.86
.83
.96

$0.85
.87
1.09

$1.03
1.09
1.28

Average monthly earnings
Institutional:
All positions:
Living in hospital quarters
_ _ __
Living outside hospital quarters _ _ ____
Receiving no meals_____ ______ ______________
Receiving 1 or more meals daily
___
Head nurses:
Living in hospital quarters _
_
Living outside hospital quarters
__
General staff nurses:
Living in hospital quarters_______________________
Living outside hospital quarters___________________
Receiving no meals_________________ _________
Receiving 1 or more meals daily________________
Private duty 41....................................................................................
.
*
3
Public health:
All positions _
____
_
School nurses _
...
_
______ _._
Staff muses
_
__
_ _____
Industrial ________ _ _ _
Office _ _ _ _ _ _ _ _ _
Nurse educators:
Living in hospital quarters___________________________
Living outside hospital quarters_______________________
Institutional: hospital quarters _ _ _ _ _ _
Living in
Living outside hospital quarters
_
Public health
__
_ _ _ _ _

899
3,443
1,686
1,757
181
735
300
1,509
746
763
2,155
1,243
297
555
876
914
122
257

$160
172
188
158
153
182
151
161
178
151
153
184
182
177
196
167
194
207

$144
153
163
149
134
162
129
148
157
144
144
164
154
162
182
144
192
188

$153
162
182
154
148
179
141
152
163
150
151
181
183
170
194
152
193
204

$154
169
197
158
150
186
148
154
182
150
156
182
164
164
190
164
224
210

$155
165
199
154
152
166
150
166
198
151
160
172
(«)
163
193
152
179
225

$168
174
184
161
164
181
158
162
171
156
153
194
193
184
194
165
199
215

$154
159
171
153
160
162
148
153
169
147
154
177
173
176
183
151
(«)
184

Average hourly earnings«
778 $0.77
3,054
.87
1,060 1.08

$0.69
.78
.96

$0.75
.83
1.09

$0.79
.84
1.09

$0.76
.81
.96

$0.79
.87
1.12

$0.74
.77
.94

i Median. Actual rather than scheduled hours on duty are shown here.
Earnings include cash paid in lieu of maintenance, but exclude the cash
equivalent of maintenance provided by employers.
3 The regions used in the study include: New England—Connecticut,
Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont;
Middle Atlantic-New Jersey, New York, and Pennsylvania; Border States—
Delaware, District of Columbia, Kentucky, Maryland, Virginia, and West
Virginia; Southeast—Alabama, Florida, Georgia, Mississippi, North Caro­
lina, South Carolina, and Tennessee; Great Lakes—Illinois, Indiana, Michi­
gan, Minnesota, Ohio, and Wisconsin; Middle West—Iowa, Kansas, Missouri,

Nebraska, North Dakota, and South Dakota; Southwest—Arkansas, Loui­
siana, Oklahoma, and Texas; Mountain—Arizona, Colorado, Idaho, Montana,
New Mexico, Utah,
and Washington. and Wyoming; and Pacific—California, Nevada, Oregon,
3Includes data for nurses who did not indicate living arrangements.
4 Includes 139 nurses who did not work in October 1946.
3Insufficient number of replies to justify presentation of an average.
6 For information on hourly rates of private duty nurses, see table 9; for
hourly earnings of industrial and office nurses and nurse educators in the
country as a whole, see table 8.

The one institutional nurse in five who occupied
hospital quarters earned an average of $160 in
October 1946 ($37 a week)—$3 a week less than
those who provided their own living quarters.
One out of four received less than $140 a month in
cash. Apparently because a greater proportion of
nurses in the higher-paid supervisory positions five
in hospital quarters, cash earnings of a fourth of
both nonresident and resident nurses exceeded
$200. The spread in earnings between nurse
educators occupying hospital quarters and those
living outside was about the same as for institu­
tional nurses but full-time instructors living in

earned $20 less than instructors who occupied
their own quarters.




Hourly Earnings 1
5

The earnings of all nurses (excluding the one in
eight who lived in hospital quarters) averaged ap­
13 Hourly rates rather than hourly earnings in the case of private duty
nurses. Average hourly earnings have been computed by dividing monthly
earnings of each nurse by her monthly hours on duty and then determining
the median. Because the nurses who worked the longest hours tended to
have lower-than-average hourly earnings, the actual average hourly earnings
are generally above the figure that would be obtained by dividing average
(median) monthly earnings of all nurses by average (median) hours of all
nurses.

PART I.

13

ACTIVE NURSES

proximately $1 an hour in October 1946; about
one-fourth received less than 83 cents and one in
four was paid more than $1.10 (table 8).
Because of differences in hours worked, the
variation in hourly earnings among branches of
nursing did not correspond closely to the variation
in monthly earnings. Most notably, the short
hours of private duty nurses reduced their monthly
earnings to the lowest in the profession while their
typical hourly rate ($1) appreciably exceeded the
hourly earnings of institutional and office nurses
and was practically the same as that of nurse
educators. Industrial nurses, whose monthly

earnings were exceeded by those of nurse educators,
had the highest hourly pay ($1.11). Public health
nurses also earned more on an hourly basis than
nurse educators although they had lower monthly
earnings.
Institutional nurses received distinctly the
lowest hourly pay of any group in the profession—
87 cents for those providing their own living
quarters. One in four received less than 75 cents.
Average hourly earnings of institutional nurses
living in hospital quarters were 10 cents below
those of nurses living outside these quarters.
The difference in the cash hourly earnings of

T able 8.—Percentage distribution of nurses, by average hourly earnings,1 October 1946
Nurses living outside hospital

Average hourly earnings

All
Institu­ Public
fields3 tional health

Under 50.0 cents...............................................................................
50.0 and under 59.9 cents......... ......................................................
60.0 and under 69.9 cents.................................................................
70.0 and under 79.9 cents.................................................................
80.0 and under 89.9 cents.................................................................
90.0 and under 99.9 cents................ ................................................
100.0 and under 109.9 cents..............................................................
110,0 and under 119.9 cents . _ _ _ _ _ _ __
120.0 and under 129.9 cents..............................................................
130.0 and under 149.9 cents
140,n and under 139.9 cents..............................................................
_ __
150.0 and under 159.9 cents..............................................................
160.0 and under 169.9 cents............................................................
170.0 and under 179.9 cents......... ...................................................
180,0 and under 189.9 cents
__ ___
_
___
_ _
190,0 and Under 199.9 cents ,
.
_
_
_ ...
200.0 cents and over............. ....... ....................................................
Total...................-..........................-.......................................
Number of replies to question..................................—.................
Average 4 hourly earnings of all nurses........................................

0.8
2.8
5.9
11.1
14.5
9.0
30.5
8.2
7.9
2.7
1.7
1.3
1.0
.5
.4
.2
1.5
100.0
8,500
$1.00

1Hourly rates of private duty nurses. Includes cash paid in lieu of main­
tenance but excludes the cash equivalent of maintenance provided by em­
ployers.
2 Includes data for private duty nurses and other nurses employed in fields
not shown separately. Hourly rates of private duty nurses are presented in
table 9.

1.3
5.6
11.9
18.8
18.8
10.6
13.3
7.2
4.2
2.5
1.6
1.0
.9
.3
.2
.1
1.7
100.0
3,054
$0.87

0.4
1.0
2.5
7.8
12.7
11.1
17.4
13.3
10.3
7.3
4.7
3.1
2.3
1.6
1.4
.7
2.4
100.0
1,061
$1.08

Indus­
trial
0.3
.3
1.5
3.7
10.3
10.6
21.8
20.8
13.0
6.3
3.5
2.7
2.5
.4
.4
.1
1.8
100.0
679
$1.11

Nurses living in hospital

All
Nurse
Nurse
Office educators fields3 Institu­ educators
tional
1.5
4.5
8.2
14.3
15.9
12.4
17.7
9.2
5.7
3.2
2.0
1.1
.5
.6
.8
2.4
100.0
785
$0.95

0.9
.9
7.0
8.0
12.7
21.1
27.7
8.0
2.8
.5
3.8
1.9
1.4
.5
2.8
100.0
213
$0.99

4.5
12.9
20.2
16.4
9.9
9.4
8.4
5.1
4.2
1.9
2.0
1.3
.8
.7
.3
.2
1.8
100.0
946
$0.78

4.8
12.2
20.9
17.8
10.7
8.6
7.6
5.5
3.9
1.5
2.2
1.2
.9
.4
.4
.1
1.3
100.0
778
$0.77

0.9
19.4
19.4
9.3
4.6
13.0
16.8
4.6
1.9
.9
1.9
.9
.9
.9
4.6
100.0
108
$0.83

3Includes data for nurses employed in fields not shown separately. Private
duty, public health, industrial, and office nurses live outside hospital
quarters.
4 Median.

T able 9.—Percentage distribution of private duty nurses, by hourly rates of pay, October 1946
Hourly rates
75 cents............................................................................
80 cents
____ - 85 cents
90 cents
95 cents

________________________________
_ _______________________________
_ _ _____________________________

$1.00.................................................................................
$ 05— 10
1 $
1
___ _ ________ ________
$1 15-$1 90
$1 95
Over $1.25
___________________________
Other amounts.......................................... - ...................
Total......................................................................
Number of replies to question............. - ......................
1Hourly rates concentrated at 87.5 cents.




United New Middle Border
States England Atlantic States
4.3
.8
6.4
2.6
.8
60.1
4.7
2.9
10.1
1.0
6.3
100.0
2,483

8.9
2.6
22.1
7.0
1.8
34.0
1.8
.4
1.1
.4
119.9
100.0
271

5.0
.4
7.7
3.1
.9
63.3
3.8
2.2
7.2
1.0
5.4
100.0
680

10.5
5.8
1.7
.6
78.5
.6

2.3
100.0
172

South­
east
7.1
1.6
4.0
5.6
1.6
48.3
4.0
4.0
11.1
.8
111.9
100.0
126

Great
Lakes
1.9
.9
2.9
1.2
.9
70.6
6.0
3.3
8.4
.5
3.4
100.0
646

Middle
West

South­
west

Moun­
tain

2.8
1.4
2.8
1.4
86.0
1.4

1.4
2.8
1.4
75.6
1.4
13.9
2.1
1.4
100.0
144

3.7
4.9
1.2
80.5
6.1
1.2
2.4
100.0
82

.7
3.5
100.0
142

Pacific
0.5
.5
1.4
9.1
14.5
14.1
49.9
3.2
6.8
100.0
220

14

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

these two groups was proportionately greater
than the variation in their monthly earnings since
hospital residents worked distinctly longer hours
than those living outside.
Rates of private duty nurses were characterized
by a high degree of concentration at $1 an hour:
this amount was reported by three out of five
nurses in this field in October 1946. One in ten
earned $1.25, rates of the remainder ranging from
75 cents to over $1.25 (table 9).
Supplementary Maintenance

The earnings of nurses providing their own
living quarters, discussed in the preceding pages,
are frequently supplemented by meals and laundry
(table 10). On the average, each nurse providing
her own living quarters received one meal a day
in addition to her salary in October 1946.
Provision of meals and laundry was most com­
mon for institutional nurses. About two-fifths of
the nurses in this field who resided outside hospital
quarters received laundry of their uniforms and
about half were provided one or more meals daily;
averaged over all institutional nurses living out­
side, these would have amounted to about one
meal a day for each nurse.
There was a marked difference in the cash earn­
ings of institutional nurses, depending on whether
they received some meals in addition to their cash
salaries. Those provided no meals averaged $188
compared with about $158 for those receiving some
meals—a daily difference of $1 for between one and
two meals. Allowance for meals and uniforms
provided institutional nurses would have about
equalized their monthly pay with that of public
health nurses—the only major field of nursing in
which both provision of meals and laundry of
uniforms was rare—but it would not have equalized
hourly earnings.
Meals and laundry were somewhat less com­
monly provided for nurse educators than for
institutional nurses. The cash earnings of a
substantial proportion of private duty nurses
were also supplemented by one or more meals
daily when on duty.16 Provision of meals was
unusual for industrial, public health, and office
nurses, as was laundry of uniforms for those in
the private duty and public health fields.
18 Half of the private duty nurses who reported on this point received
meals (typically one a day), but such a large group did not answer the ques*
tion regarding supplementary maintenance that generalization as to the
exact extent of the practice is difficult.




T a b l e 10. —Percentage

distribution of nurses, by kind of
maintenance 1 'provided, October 19J+6
All Insti­ Nurse
fields2 tution­ educa­
tors
al

Kind of maintenance provided
Nurses living in . ,

13.6 20.7
.9
1.3
_
T _ _
2.4
1.8
10.9 17.0
Room, board, and laundry of uniforms..............
Nurses living out .
,
86.4 79.3
1 meal a day .
_________
10.0
7.8
2 meals a day__ ______
4.4
5.0
2 meals a day
. ....
_
_
1.4
1.6
5.4
8.9
1 meal a day and laundry of uniforms3........................
8.9
2 meals a day and laundry of uniforms3...................... 5.0
8.8
3 meals a day and laundry of uniforms3...................... 5.2
9.1
Laundry of uniforms only 3_ . ............................................. 12.4
No maintenance, or uniforms only........................... 42.0 29.8
Total_______ ________________ . _____________
100.0 100.0
Number of replies to question_______ _______ ____ 8,750 4,346
Room o
n
Board and room

___

l

y

.

____

_

___

32.3
1.6
2.6
28.1
67.7
3.2
3.4
1.6
7.9
6.8
9.2
6.1
29.5
100.0
380

Kind of maintenance provided

Pri­ Pub­
vate lic Indus­ Office
duty health trial

1 meal a day........................................................
2 meals a day.
__
. ... . _ _
3 meals a day___________________________
1 meal a day and laundry of uniforms3...........
2 meals a day and laundry of uniforms 3_........
3 meals a day and laundry of uniforms3.........
Laundry of uniforms only3...............................
No maintenance, or uniforms only..................
Total..........................................................
Number of replies to question............ .............

33.9 2.8 0.3
2.3
.1
.4
15.6
.1
.5
2.3
.4 1.3
1.3
1.3
.1
.3
.6
.3
.3
.5
.3
.6
.8 4.7 51.8 27.6
44.9 91.5 46.0 67.1
100.0 100.0 100.0 100.0
1,368 743 687
767

*In addition to cash salary.
2Includes data for categories not shown separately.
3Includes nurses who are also provided uniforms.

Regional Differences

Regional differences in salaries were referred
to by a few participants in the study as reasons
for migration from one area to another; there
was greatest satisfaction with salaries on the
West Coast, where hourly and monthly earnings
were generally highest. Two participants in the
study commented:
My chief reason for coming to California to work
was the fact that the salaries were better out here and
also shorter week.
Many nurses are leaving the State of Pennsylvania
because it is much more profitable to work elsewhere.
Pennsylvania is one of the least progressive of States
in regard to the nursing situation.1
17
8

New England nurses usually had the lowest
earnings, but the position of other parts of the
country varied more or less among the different
fields of nursing. In general, four other regions—
Middle Atlantic, Border States, Southeast, and
17 Earnings in Pennsylvania were apparently below the average for the
Middle Atlantic States as a whole.

PART I.

15

ACTIVE NURSES

Middle West—ranked next to New England in
monthly earnings, with relatively little variation
in salary levels among them. In several fields,
earnings in the Great Lakes, Southwest, and
Mountain States were above those in all other
regions except the Pacific,, but their position
relative to each other varied from one field of
nursing to another.
The regional picture of earnings holds true not
only for nurses receiving no maintenance but
for those receiving meals and for those living in.
Provision of meals was most common in the East
(including the Southeast) and least common in
the Pacific region. Earnings of institutional
nurses living in their own quarters on the Pacific
Coast averaged over $25 a month more than in
those in the next highest salary region and $50
above New England. In the three fields for
which average hourly earnings were computed

by region (institutional, private duty, and public
health) the lowest hourly, as well as monthly,
pay was generally found in New England and
the highest in the Pacific States. Earnings of
public health nurses in the Southeast and South­
west were also low. Because of shorter hours on
the Pacific Coast, the regional range in hourly
earnings of institutional nurses, presented in chart
2, is proportionately greater than that in monthly
earnings.
There was less regional variation in average
monthly earnings in private duty work than in
other branches of the profession (from $144 in
New England to $163 in the Southwest). This
narrow range was due primarily to a high degree
of uniformity in hourly rates throughout the
country outside New England and the Pacific
Coast. (In all regions except New England, the
Southeast, and the Pacific Coast, at least three

REGIONAL MAP OF
A verage H ourly Earnings O f Institutional N urses
Laving O utside H ospital Quarters




OCTOBER 1946

NEW EN6LAN0

16

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

out of five private duty nurses received $1 an institutional nursing) also tended to provide the
hour. Only in New England did more than a lowest cash salaries; and earnings of nurse educa­
third of the private duty nurses receive less than tors and public health nurses, who have the most
$1 an hour; there three out of five earned less than graduate education, were above average.19
this rate. Half of those doing special duty on the
Institutional and public health nurses employed
Pacific Coast were paid $1.25 an hour.) More­ by the Federal Government received higher sal­
over, because of relatively long monthly hours on aries than others in these fields. Other govern­
duty in the Southeast and the comparatively ment agencies ranked next, nongovernmental
large proportion of private duty nurses in the agencies paying the lowest salaries. Salaries of
Great Lakes and Pacific regions who did not work other government agencies were closer to private
any hours in October, average monthly earnings than to Federal Government levels. The salary
in the Southeast and Southwest were on a level spread between different types of agencies was
with those on the Pacific Coast and above those smaller in public health than in institutional
in the Great Lakes States.
work—about $35 to $40 compared with $50 a
The regional picture of earnings in the public month (for nurses living outside hospital quarters).
health and industrial fields differed somewhat
In October 1946, mental hospitals paid higher
from that in other branches of the profession. monthly salaries to their nurses than did general
Both monthly salaries and hourly earnings of hospitals.20 Earnings also tended to increase with
public health nurses were relatively low in the hospital size, those in hospitals of 1,000 beds or
Southeast and Southwest, with earnings of staff more averaging about $45 a month more than
nurses in these sections on a level with those in those in hospitals with less than 50 beds. Meals
New England. The lowest average pay of indus­ were provided nonresident nurses most frequently
trial nurses was reported by the comparatively in small hospitals, although allowance for these
small number in the Mountain region. In this meals would not equalize earnings in different­
field, earnings in the highly industrialized Middle sized institutions.
Atlantic and Great Lakes States varied little from
Earnings tended to be higher in large communi­
the pay levels in the Border States, the Southeast, ties although this pattern was not entirely con­
and the Southwest.
sistent. The higher monthly earnings reported
by private duty nurses in large communities are
Factors in Earnings Variations
primarily traceable to longer hours of work but
Earnings tended to increase with age and are partly due to differences in hourly rates. Al­
experience. There was also some tendency for though $1 was the most common hourly rate for
salaries to be higher among those with some gradu­ private duty work in communities of all sizes, 1 out
ate study but this variation was not large or en­ of 5 nurses in cities of over 500,000 received $1.25,
tirely consistent. Salaries of those with a 4- or compared with 1 out of 20 in communities of less
5-year or a 24- to 35-month basic course were than 100,000.
somewhat higher than those of nurses with a 36Hours on Duty
month course. The higher earnings for those
with only 24 to 35 months of basic education were
Participants in the survey were asked to report
apparently due to the longer experience and both scheduled hours on duty—the amount of
greater age of this group. The size of the hospital time they were normally supposed to work—and
in which the nurse was educated apparently had
variation in earnings
little influence on earnings.18 Aside from the in18 In evaluating thefor public health nurseswith education, it should be borne
mind that, except
and nurse educators, a very large
education. No attempt was made to
relationship within individual fields between majority haveinno graduateprivate duty nurses with age, experience,analyze
the variation earnings of
or
earnings and age, experience, and amount of cation; their hourly rates are relatively uniform and are determined edu­
pri­
marily community
In a
work is plentiful an
education, those fields characterized by the lowest analysisby the variation practice.monthlyperiod when hours would probably
of
their
earnings or
average age and years of experience (office and not reflect differences ininemployment opportunities so much as personal
18Partly because of the growth of the average hospital in recent years, there
was also a tendency for nurses with the longest years of experience to be
graduates of schools affiliated with small hospitals.




preference.
28 Classification of nurses according to the type of hospital in which they
were employed provided sufficient information on earnings only for these
two groups of institutions.

PART I.

17

ACTIVE NURSES

hours actually worked in October 1946.21 (These
two measures of hours may differ because of ab­
sence or compensatory time off, on the one hand,
and duty during “ on call” hours or other over­
time, on the other.) What did these participants
report?
Scheduled Hours

Eight hours comprised the typical workday in
all fields of nursing, but weekly schedules varied
markedly among and within the different branches
of the profession. Work schedules were generally
the same on day, evening, and night shifts. With
the vast majority on an 8-hour day, less than 1
nurse in 10 worked 9, 10, or 12 hours daily, and
substantial groups in all branches but institutional
nursing and nursing education had a somewhat
shorter workday in October 1946. Hours in ex­
cess of 8 a day were more common for office and
private duty nurses than for institutional nurses
and nurse educators and were rare in industrial
and public health work (tables 11 and 12).
Weekly schedules varied from less than 40 to
72 hours but the vast majority ranged from 40
to 48 hours. The longest schedules were those of
institutional nurses, half of whom were on 48hour weeks. Even in this field, however, one in six
was on a 40-hour week and the same proportion
worked a 44-hour schedule. Sixty- and 72-hour
weeks, though still reported and slightly more
common on the night shift, were unusual on all
shifts.
» Both scheduled and actual hours on duty exclude meal periods and time
on call. Actual hours on duty indude duty during on call periods but
scheduled hours do not.

Outside institutional work, where schedules
were longest, most workweeks did not exceed 44
hours.22 Thus, in nursing education, where hours
ranked next to those in institutional nursing, the
most common single schedule was 44 hours a
week. Next most frequent was a 48-hour week.
Schedules of individual office nurses varied con­
siderably but the most usual schedule reported by
these nurses was a 44-hour week.
Table 11.— Usual scheduled hours on duty1 of nurses on
the day shift, October 1946
Percent of nurses
Scheduled hours on duty
Less than 8 hours a day and
40 a week.............................
8 hours a day and 40 a week..
8 hours a day and 44 a week..
8 hours a day and 48 a week..
9 hours a day and 45 a week..
9 hours a day and 54 a week..
10 hours a day and 50 a week—
’12 hours a day and 60 a week..
12 hours a day and 72 a week..
Other periods __ _ , ^
Total
Number of replies to question.

Nurse
All Insti­ Public Indus­
tu­
fields2 tional health trial Office educa­
tors
13.5 5.2 36.3 11.8
24.2 17.7 33.6 61.4
19.6 16.6 21.0 11.2
32.3 50.5 2.1 9.2
1.4
.5 1.5
.9
2.2 2.6
.1
.5
.8
.1
.8
.2
.3
.4
.1
.2
.3
5.5 5.0 6.2 4.2
100.0 100.0 100.0 100.0
6,995 3,815 1,061 618

25.4
4.7
17.5 13.6
29.4 40.5
10.2 30.0
4.8
1.3
3.6
3.4
2.4
.8
.6
.4
5.7
5.7
100.0 100.0
778
383

1Excludes hours on call and meal periods.
* Excludes private duty nurses but includes data for other nurses employed
in fields not shown separately.

A large majority of the industrial and public
health nurses worked 40 hours or less. The
schedules of industrial nurses exceeded only those of
public health nurses and apparently corresponded
closely to those of other workers in the plants in
which they worked. The scheduled workweek in*
* Private duty nurses, of course, do not have scheduled workweeks.

T able 12.—Usual daily hours on duty1 of private duty nurses, October 1946
Percent of nurses
Usual daily hours
7 hours
7H hours______________________ _____
8 hours___ ___________________ ____
9 hours_____ __________ ____________
1ft hours ________ _________________
11 hours
_ ______________
12 hours______ ______________________
Other period________________________
Total__________________________
Number of replies to question....................
1Excludes meal periods.
784041°—48---- 4




United
States
0.6
14.4
73.7
.9
1.5
.9
6.2
1.8
100.0
2,567

New
Middle
England Atlantic
16.1
69.2
.7
2.0
1.0
7.0
4.0
100.0
299

1.7
16.1
71.2
.7
1.1
.4
7.1
1.7
100.0
715

Border Southeast
States
14.9
66.0
.5
.5
3.1
12.4
2.6
100.0
194

13.6
74.4
2.4
1.6
.8
5.6
1.6
100.0
125

Great
Lakes
16.5
75.8
.6
1.7
.9
3.1
1.4
100.0
635

Middle
West
1.3
12.5
73.7
2.0
2.6
5.9
2.0
100.0
152

South­ Mountain Pacific
west
0.7
5.9
76.2
.7
2.0
.7
13.1
.7
100.0
152

11.9
847
1.7
1.7
100.0
59

0.4
9.4
82.7
2.1
1.3
.8
2.5
.8
100.0
236

18

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

public health work was the shortest in any branch
of nursing. Over a third worked less than 40
hours and another third were on 40-hour schedules.
Schedules of less than 8 hours a day and 40 hours a
week were reported by about half the school
nurses, as contrasted with one-third of the other
public health nurses.
Actual Hours on Duty and Overtime

The actual time on duty of the average nurse
amounted to 191 hours a month (about 44 hours a
week) in October 1946 (table 13). A comparison
T able 13.—Percentage distribution of nurses, by actual
monthly hours on duty} October 1946
In­
Pri­
Actual monthly hours All Insti­ vate Public dus­ Office Nurse
edu­
tu­
nurses2 tional duty health trial
on duty
cators
Under 85 hours...................
85 and under 95 hours........
95 and under 105 hours—
105 and under 115 hours—
115 and under 125 hours...
125 and under 135 hours.._
135 and under 145 hours...
145 and under 155 hours...
155 and under 165 hours.—
165 and under 175 hours—
175 and under 185 hours—
185 and under 195 hours—
195 and under 205 hours—
205 and under 215 hours—
215 and under 225 hours...
225 and under 235 hours...
235 and under 245 hours...
245 and under 255 hours...
255 and under 265 hours—
265 and under 275 hours__
275 and under 285 hours—
285 and under 295 hours__
295 and under 305 hours—
305 hours and over.............
Total____________
Number of replies to
question...........................
Average3 monthly hours,
all nurses.........................

8.0
.7
1.9
1.6
1.4
1.3
2.1
2.0
6.2
8.7
9.6
10.8
7.9
13.7
11.0
2.7
3.0
3.1
.9
.5
.5
.3
.4
1.7
100.0

4.1
.5
1.7
1.1
.8
.9
.9
.9
3.1
4.9
6.0
11.8
8.2
23.0
17.2
4.0
3.5
2.4
1.2
.7
.7
.4
.4
1.6
100.0

22.2
1.5
3.8
4.0
2.9
2.1
4.1
2.1
6.1
6.1
5.4
4.7
6.0
4.2
6.5
1.5
4.3
7.8
.3
.4
.5
.2
.3
3.0
100.0

3.2
.1
.6
.9
.8
2.0
3.1
6.8
13.0
18.8
21.1
13.4
8.5
2.5
2.2
.6
.6
.6
.3
.2
.1
.3
.3
100.0

2.1
.3
.4
.7
1.1
.4
1.1
.9
15.3
22.2
26.3
9.0
6.8
6.4
4.3
.7
.9
.4
.3

—

5.5 2.4
1.3
1.6 .........*5
.8
.5
1.6
.8
1.1
.5
3.4 1.1
3.3
.3
8.0 2.6
10.9 6.8
12.1 4.2
14.1 23.1
10.3 11.1
8.2 18.1
7.4 13.1
2.2 3.2
2.2 2.1
2.3 1.6
1.4 2.4
.4 1.1
.4
.8
.5
.2
.8
1.3 2.4
100.0 100.0 100.0
-

9,874 4,415 2,040 1,088 701 829
191 207 167 175 177 185

380
201

i Excludes meal periods.
*Includes data for nurses employed in fields not shown separately.
3Median.

of actual and scheduled hours indicates that over­
time was common, though two out of five nurses
stated that they seldom worked beyond their
scheduled hours.23
The rank of the six fields of nursing with respect
to actual hours was similar to that with respect to
scheduled hours. Thus, actual hours were longest
for institutional nurses. In October 1946 the
** It was not possible to measure the exact amount of overtime because of
the fact that absenteeism and turn-over, as well as compensatory time off,
offset to an undetermined extent the effect of overtime, also because of possible
inaccuracies in information obtained by means of a mail questionnaire.




average institutional nurse reported that she was
actually on duty for 48 hours a week—207 hours
a month. Nurse educators averaged about 1
hour a week less. Office nurses worked about 5
hours a week less than institutional nurses; public
health and industrial nurses were on duty about
41 hours, and private duty nurses worked about
39 hours a week.
Although comparatively few schedules exceeded
48 hours, substantial groups of institutional and
office nurses and nurse educators actually were
on duty at least 50 hours (215 hours during the
month). Altogether one out of four nurses
worked at least 50 hours weekly (chart 3). One
participant in the study commented:
When a nurse accepts a position, especially in a
doctor's office, she is told the office hours are such and
such but those hours are never kept because the
doctor will continue to make appointments long after
specified hours, never giving a thought or considera­
tion to the nurse who has been working, going on high,
for 9 hours already. . . . I think we should receive
pay for hours overtime.

In public health work, the existence of some over­
time was evidenced by the fact that although
schedules in excess of 44 hours were rare, about 1
in 10 actually worked from 45 to 49 hours and
1 in 20 worked at least 50 hours. Although
only a minority of industrial nurses stated that
they seldom worked overtime, comparison of
actual and scheduled hours indicate that over­
time was not extensive.
Probably the most important characteristic of
time worked by private duty nurses is the wide
variation in their monthly hours. About one in
four worked at least 215 and a similar group
worked less than 95 hours. Indeed, some did not
go on duty at all during October.* With the short­
24
*
age of nursing care, this variation apparently did
not reflect differences in opportunities so much as
personal preference and the duration of cases;
however, some of the difference may still have
been due to varying opportunities for work, since
those in small communities worked the shortest
hours.
Among institutional nurses, those in supervisory
positions and those occupying hospital quarters
worked the longest hours. Resident nurses aver­
aged about 4 hours a week more than nonresidents;
24 Only those who had been on a case within 3 months were classified in
private duty work.

PART I.
—

.....

^*-.n.-L— *-..... » * ............. ............------------------------------------------------------ ---------- -----------

19

ACTIVE NURSES
-

»

-

—

...................- * « - « ------ » - ...................... —

•*"....... . .

< . ...... ■..T..M^ A .,A ..r.....A A ..... ^ .A ..^ .
■

Actual Hours W orked ByProfessional Nurses

PERCENT L &
OF NURSES f ^

October 1946

UNDER

85

175
HOURS PER MONTH

UNITED STATES DEPARTMENT OF LABOR
BUREAU OF LABOR STATISTICS

nonresidents who received meals also were on duty
about 1 hour a week more than those providing all
their own maintenance.26 Head nurses, who are
responsible for an entire floor or ward, worked
longer than institutional general staff nurses in
October 1946—209 and 202 hours, respectively.
(The variation in hours between residents and
nonresidents results in part from the higher pro­
portion of supervisory nurses who occupy hospital
quarters. However, distinct variations in hours
with living arrangements were found for general
staff nurses as well as for all nurses.)
Regional Differences in Hours

appeared to be relatively long in several branches
of nursing.
In institutional work there was comparatively
little regional difference in hours on duty except
between the Pacific Coast States and the rest of
the country; the average workweek was 44 K hours
in those States compared with 48 or 49 hours in
each of the other regions. Half the Pacific Coast
nurses were on 40-hour schedules. Private duty
nurses in the Southeast worked distinctly longer
hours than did nurses in other parts of the country.
Factors in Hours Variations

Hours varied considerably among hospitals
operated by different types of proprietors and
On the whole, hours were shorter on the Pacific
there was
of
Coast than in other regions. In three fields, Middle communitysome difference in hours with size in
and size of hospital. Nurses
Atlantic nurses reported slightly shorter hours, but Federal hospitals had both the shortest scheduled
in other branches of the profession hours in that and the shortest actual hours. However, among
region were not notably short. There was no Federal nurses, those in the armed services worked
region that showed the longest hours in all fields almost as long as those in other hospitals—they
although hours in the Middle West and Southwest* were on duty 47 hours a week while hospital
nurses employed by nongovernmental agencies as
* This fact appears to be related to more frequent provision of meals in
well as by State, county, and municipal govern­
smaller hospitals, which have somewhat longer hours than larger institutions.




20

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

ments all averaged 48 hours during October 1946.
Hospitals operated by different types of proprie­
tors did not differ markedly in the proportion of
nurses who were required to work overtime.
In all types of public health agencies the pre­
dominant work schedule was 40 hours a week or
less and there was little variation among them in
the proportion of nurses required to work over­
time. Except for Federal Government employees,
substantial groups employed by all types of pub­
lic health agencies worked less than 40 hours.
Hours were shortest for nurses in municipal agen­
cies, presumably because many of them were
school nurses who frequently worked on schedules
of less than 40 hours.
There was some tendency for both scheduled
and actual hours to decrease as size of hospital
(measured in terms of number of beds) increased.
Actual hours on duty appeared to be slightly
shorter in tuberculosis than in mental or general
hospitals.
Both scheduled and actual hours tended to be
shortest in large communities except among
private duty nurses, where actual hours on duty
were longer in large than in small cities. Daily
hours of private duty nurses tended to decrease
as size of community increased although the
8-hour day was most common in areas of all sizes.
Schedules were particularly long in communities
of less than 25,000, where 1 out of 7 reported 12hour days. In general, hours schedules in this
field were more uniform in large than in small
communities. In institutional work the 48-hour
week was most common and longer hours were
rare in communities of all sizes; however, almost
half the hospital nurses in cities of 250,000 or more,
contrasted with only one-third in smaller commu­
nities, had work schedules of less than 48 hours.
Hours On Call and Split Shifts

Do hours on duty indicate fully the extent to
which nurses7 freedom is limited by their work?
In order to ascertain the extent to which this
freedom is curtailed during off-duty hours, infor­
mation was obtained on the prevalence of split
shifts and time on call. The replies indicate that,
although the typical nurse of today is not required
to be on call beyond her regular hours on duty and
her daily working hours are not broken beyond
meal periods of an hour or less, the exceptions to
this usual pattern are substantial.




The problem of time on call is limited to nurse
educators, institutional nurses, and public health
nurses, while split shifts are essentially confined
to the first two groups. Among these fields, the
length of time on call was somewhat greater for
institutional nurses although a slightly higher
proportion of those in public health work were
subject to call for some time during October 1946.
About one-fourth of the institutional nurses and
nurse educators and 3 out of 10 public health
nurses who replied to the question were required
to be on call in October;26 of these, the proportions
with less than 10 hours on call in the month were
about one-sixth,27 one-fourth, and two-fifths, re­
spectively (table 14). In contrast, one in three
institutional nurses and one in five nurse educators
and public health nurses subject to call reported
that such time amounted to at least 100 hours
during the month of October. Presumably those
required to be available for emergency duty for
such long hours include public health nurses in
small communities.
I am the only public health nurse in this small town
and I am on call 24 hours a day. Now, this doesn't
mean that I am called out every night in the week
after working all day, but it does mean that in case of
an emergency or if someone wants a home delivery,
I am duty bound to assist.

A large majority of those subject to call in
October 1946 were actually summoned to duty for
some time during this period. However, these
periods of work, which are included in the actual
hours on duty described previously, typically were
considerably shorter than the total time on call.
Thus, a substantial proportion of these hours on
call represent a limitation on freedom beyond time
on duty. Over four out of five of the institutional
nurses with hours on call were actually summoned
to work for some time during these periods in
October 1946, typically for less than 10 hours
(table 15). Excluding the time actually spent on
duty during on-call periods, hours on call averaged
about 35 hours a month for those institutional
nurses subject to this requirement.
Split shifts, though not a major grievance
because they are required of only a minority of all
nurses, were a frequent source of complaint among
those required to work such shifts and were a
* A fairly large proportion of the participants in the survey failed to answer
the question regarding time on call and split shifts.
27 Eight percent of all hospital nurses replying to the question.

PART I.

21

ACTIVE NURSES

T able 14.—Monthly hours on call,1 October 1946
United New Middle Border
States England Atlantic States

Hours on call1

South­
east

Great
Lakes

South­
west

Moun­
tain

70.5
29.5
6.4
4.5
1.3
.6
3.8
1.3
1.3
10.3
100.0
156

72.1
27.9
4.1
2.0
1.4
2.7
2.0
.7
2.7
12.3
100.0
147

81.2
18.8
2.6
3.1
1.4
1.2
1.6
1.4
.9
6.6
100.0
576

63.8
36.2
6.3
4.3
4.3
4.3
4.3

81.4
18.6
2.3
4.7
2.3

77.5
22.5
7.5
2.5
2.5

78.3
21.7
9.7
4.8
2.4
3.6

12.7
100.0
47

9.3
100.0
43

2.5
7.5
100.0
40

Middle
West

Pacific

Percent of institutional nurses
No hours on call..................-.........................................
Hours on call..................................................................
1 and under 10.........................................................
10 and under 20—...................................................
20 and under 30........................................................
30 and under 40_.....................................................
40 and under 50_-...................................................
50 and under 75.......................................................
75 and under 100. -..................................................
100 and over.............................................................
Total............ .........................................................
Number of replies to question.....................................

75.2
24.8
4.4
3.9
2.1
1.3
1.7
2.0
1.5
7.9
100.0
3,955

70.5
29.5
4.1
5.1
3.6
2.6
1.8
3.6
1.8
6.9
100.0
390

75.0
25.0
4.8
4.5
2.8
1.3
1.5
1.8
1.4
6.9
100.0
919

73.1
26.9
4.2
3.1
1.9
1.5
3.8
1.2
2.3
8.9
100.0
260

71.3
28.7
2.4
2.4
1.9
1.4
1.0
3.8
1.9
13.9
100.0
209

77.6
22.4
5.1
3.8
1.5
.9
1.2
2.0
1.4
6.5
100.0
1,042

69.0
31.0
5.9
4.3
2.0
1.2
1.2
2.7
.8
12.9
100.0
256

Percent of public health nurses
No hours on call______ _____________________
Hours on call..................................................................
1 and under 10........................................................
10 and under 20- ............................................ ........
20 and under 30-.....................................................
3ft and under 4ft _______ _ __
4ft and under 5 0 _____ ______________ _
fift and under 7 5 _____ _ _________________
75 and under 100 ___ _______________
100 and over.............................................................
Total....................-...................... -......................
Numb® of replies to question......................................

69.2
30.8
12.5
4.3
2.2
1.2
2.3
1.2
.4
6.7
100.0
1,043

62.9
37.1
12.0
5.3
2.3
2.3
2.3
1.5
11.4
100.0
132

62.9
37.1
15.3
4.3
2.9
2.1
2.5
1.4
.7
7.9
100.0
280

75.0
25.0
9.6
2.8
1.4
5.6
1.4
4.2
100.0
72

82.1
17.9
5.9
1.5
3.0
1.5
1.5
4.5
100.0
67

69.2
30.8
16.1
5.0
1.1
.7
1.4
1.8
4.7
100.0
279

1.2
100.0
83

Percent of nurse educators
74.4
25.6
7.1
7.1
2.6
1.1
1.1
.6
.6
5.4
100.0
8350

No hours on call.....................Hours on call............................
1 and under 10........ ..........
10 and under 20.................
20 and under 30-...............
30 and under 40- -.............
40 and under 50— ...........
50 and under 75-...........
75 and under 100................
100 and over.......................
Total____ ___________
Number of replies to question.

71.2
28.8
7.9
9.2
2.6
2.6
1.3
1.3
1.3
2.6
100.0
76

T able 15.—Hours on duty of institutional and public
health nurses and nurse educators during on call hours,
October 1946
Percent of-

No hours on duty...................................... ......
Hours on duty...................................................
1 and under 10............................................
10 and under 20..........................................
20 and under 30..........................................
30 and under 40..........................................
40 and over.................................................
Total................................................
Number of replies to question------ ----------i In addition to scheduled hours on duty.




4.8
100.0
105
Includes data for regions not shows separately.

1In addition to scheduled hours on duty.

Monthly hours on duty1

73.2
26.8
6.7
8.6
3.8
1.9
1.0

Insti­ Public Nurse
tutional health educators
nurses nurses
17.4
82.6
35.3
25.1
9.8
4.0
8.4
100.0
843

24.6
75.4
49.4
12.5
3.5
1.7
8.3
100.0
289

11.1
88.9
50.7
13.6
8.6
3.7
12.3
100.0
81

definite restriction on the freedom of substantial
numbers of nurses.
When those 8 hours are split up there are many com­
plaints, particularly from nurses who do not live in the
nurses quarters, who feel that those 3 hours off or a great
part of them are wasted.
What about the split shifts? The so-called 8-hour
day which really ends in 13 hours? A year of this just
about broke my back.

About one out of four institutional nurses and one
out of five nurse educators worked divided shifts.
The most common interval between periods on
duty was 3 but less than 4 hours a day, including
a meal period (table 16).

22

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES
T able

16.—Split shifts of institutional nurses and nurse educators, 1947

Extent of split-shift operations and daily period
between shifts1
No split shift worker! 1.

_
.
_ _ _
_
Split shift worked
Intervening period:
Under 2 hours_________________________
2 and under 3 hours_____ _______________
3 and under 4 hours____________________
4 hours ______________________________
Ovftr 4 hours
_ ......
Total
_
_
...
Number of replies to question __.

Percent
of nurse
educa­
tors,
United
United New Middle Border South­ Great Middle South­ Moun­ Pacific States
tain
States England Atlantic States east Lakes West west
Percent of institutional nurses

71.6
28.4
1.6
3.2
16.2
6.9
1.6
100.0
4,287

67.1
42.9
3.3
4.7
27.7
6.3
.9
100.0
429

67.0
33.0
1.8
5.3
18.8
5.8
1.3
100.0
1,000

1Includes meal periods.

Variations in Practices
Split shifts were apparently no more common for
general staff nurses than for all institutional posi­
tions considered as a group, while on-call time was
m ost com m on among supervisory positions.
M oreover, these supervisors were more frequently
summoned to duty during these periods than
general staff nurses. H alf the directors o f nurses
com pared with one-sixth o f the general staff
nurses were required to be on call. Nurses
assigned to operating room s also were frequently
subject to call.

I would like to explain that I liked my position as
O. R. supervisor very much, but the hours were long
and hard, work interesting and could be endured if it
were not for being on call every other night. We
took care of all YL cases besides the general patients
coming to a hospital so we had many emergencies.
No extra time given for sleep lost during night was
given. I was in charge and so was called at all hours
and often asked to do other work around hospital.
The two girls in surgery asked for $10 more per
month than the floor nurses were receiving but were
refused. They are on call nights in surgery having
but 9 nights out of a month to themselves. They
seldom get off duty after 8 hours after a heavy sched­
ule in surgery—both are married and have homes so
it makes it doubly hard to be called out in the middle
of the night. They both resigned effective February
1 but have not left yet as they have found no one to
replace them and it wouldn’t be ethical to leave sur­
gery without nurses with operations scheduled.
In a great many hospitals, in fact, probably the
majority, nurses who work in operating rooms spend
from 1 to 3 evenings a week “on call” which means of
course that they must stay at home. I have never




67.3
32.7
1.8
3.9
13.3
11.5
2.2
100.0
279

66.7
33.3
1.7
2.2
19.4
7.8
2.2
100.0
232

71.3
28.7
1.1
3.4
17.0
5.6
1.6
100.0
1,153

73.8
26.2
3.6
1.1
15.4
4.3
1.8
100.0
279

78.4
21.6
.6
1.2
9.6
9.0
1.2
100.0
166

80.7
19.3
.7
1.3
8.0
8.0
1.3
100.0
150

88.4
11.6
.7
.5
6.3
2.8
1.3
100.0
599

78.2
21.8
4.5
5.9
7.1
3.2
1.1
100. C

37*

*Except for meal period of 1 hour or less.

met any nurse to whom this time, and I mean time
that she spent actually working, having been called
to the operating room any time during the night and
having at least 2 hours there, was ever made up either
by extra time off or by overtime pay.
Tim e on call tended to be more com m on in
small hospitals and there was also a tendency for
those required to be on call in these smaller hospi­
tals actually to put in time on duty more fre­
quently. Split shifts practices did not vary
widely among different-sized institutions.
A somewhat higher proportion o f nurses em­
ployed by nongovernmental organizations than
by official public health agencies were subject to
call beyond their regular hours on duty. There
was no marked variation among hospitals operated
by different proprietors in the proportion o f nurses
required to be on call; but proportionately more
nongovernmental and municipal hospital m uses
reported that they were actually called to duty
during such hours. In hospitals o f all types of
proprietorship, however, duties during on-call
time typically amounted to less than 10 hours a
month.
Split shifts were m ost com m on in m ilitary hos­
pitals and least common, indeed almost nonexist­
ent, in veterans’ hospitals. Three out o f five
nurses in the armed services reported such work
schedules com pared w ith only one out of three or
four in other institutions.
In New England split shifts were m ost wide­
spread, where they were reported by tw o-fifths
o f the hospital nurses; they were least frequent in
the Pacific region, where they were worked by

PART I.

only about 1 out of 10 nurses. Hours on call
also appeared to be most unusual on the West
Coast and most frequent in the Middle West.
Almost one in three hospital nurses in the latter
region was required to be on call, compared with
less than one in five on the Pacific Coast.

Overtime Pay
It has already been indicated that work beyond
regularly scheduled hours was frequent in October
1946, particularly among institutional nurses,
nurse educators, and office nurses. To determine
to what extent they were compensated for this
work, the participants in the survey who stated
that they sometimes worked overtime were asked
to report on their overtime pay provisions.28
T able

23

ACTIVE NURSES

Slightly more than half of the nurses sometimes
required to be on duty beyond their regular sched­
uled hours stated that they received no compen­
sation for additional duty, though the provisions
for overtime compensation varied among fields
and were far from uniform within each field.
Except in industrial nursing, where overtime was
generally paid for at time and a half the regular
hourly rate, and in private duty, nurses who were
compensated at all most frequently received time
off rather than additional cash; and those receiv­
ing cash payment for their overtime generally
were paid their regular hourly rate (table 17).
Overtime pay was most frequent for industrial
nurses and next most common for public health
nurses. Almost all industrial nurses were paid for
such work; and, of the public health nurses who

17.— Overtime work and pay of nursesy 1947

Rate of overtime pay
Nurses who were seldom required to work overtime.............................
Nurses who worked overtime...................................-.................................
Receiving no pay and no compensatory time off..............................
Receiving compensatory time off.........................................................
Receiving same hourly rate as for regular hours...............................
Receiving time and a half for overtime. ..................... ......................
Working under other arrangements....................................................
Total..............................................................................................
Number of replies to question.....................................................................

Percent of nurses
All
fields1
44.3
55.7
29.6
10.1
5.8
5.9
4.3
100.0
10,933

Institu­
tional
36.5
63.5
38.3
12.9
5.9
2.7
3.7
100.0
5,073

Private
duty
62.2
37.8
20.2
1.1
11.6
.9
4.0
100.0
2,241

Public
health
51.5
48.5
18.1
23.8
1.5
1.6
3.5
100.0
1,102

Industrial
33.2
66.8
3.9
1.6
3.1
54.9
3.3
100.0
795

Office
52.5
47.5
34.9
4.7
2.1
1.0
4.8
100.0
866

Nurse
educators
32.6
67.4
40.6
16.9
1.0
1.2
7.7
100.0
414

i Includes data for nurses employed in fields not shown separately.

worked overtime, about three in five received
some compensation. Such pay was rare in office
work. About half of the institutional nurses and
three-fifths of the nurse educators who worked
overtime received no compensation for their extra
duty.
In hospital work overtime was appreciably less
common on the Pacific Coast than in other parts
of the country, and premium pay for overtime was
somewhat more frequent. Overtime compensa­
tion did not vary consistently among hospitals of
different sizes.

Late-Shift Work and Pay
Except for those on private duty 29 the majority
of nurses in all fields normally worked only on the
day shift. Indeed late-shift work was unusual in
office and public health work and among nurse
educators. Among those who did work late shifts,
rotation between day and other shifts was slightly
more common than continued employment on late
shifts (table 18) except for private duty nurses.

29 Particularly in a period of plentiful work, the selection of working hours
in private duty work reflects the nurses' personal choice at least in part. The
variation in the length of the time private duty nurses go on evening and
night work indicated in table 18 presumably is also related to personal prefer­
28 Those seldom required to work overtime were omitted from this analysis. ence and the way in which cases develop rather than to a set schedule such as
Any overtime pay is included in the monthly earnings reported previously.
is reflected in rotation of institutional nurses’ hours.




24

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

In turn, for those who rotated among shifts, the
interval between duty on late shifts was generally
less than a month except in institutional work.
Night work was somewhat more common among
general staff nurses than for all institutional
nurses considered as a group. Less than two out
of five assigned to general staff duties remained
constantly on the day shift.
T able 18.—Late-shift work of nurses,1 1947
Percent of—
Shift

Institu­ Private Indus­ Nurse
tional duty trial educa­
nurses nurses nurses tors

Nurses who normally worked 1 shift only. 74.0 74.7 80.2
Day shift.................................. —.......... 54.9 36.0 64.8
Evening shift................................ ... 8.8 14.5 11.9
Night shift.............................................. 10.3 24.2
3.5
Nurses who normally rotated among
shifts............................................ .......... 26.0 25.3 19.8
Evening or night shift more frequent
than once a month............................ 10.8 17.0 13.0
Evening or night shift less frequent
than once a month___ __________ 15.2
8.3
6.8
Total-------------------------------------- 100.0 100.0 100.0
Number of replies to question_________ 4,651 2,109
621

97.2
96.0
.4
.8
2.8
2.0
.8
100.0
251

1 Excludes public health and office nurses, who seldom work a late shift.

Generally the hourly rate for night work was
the same as for day work. One in three institu­
tional nurses who worked at night received higher
hourly pay than for day work; one in eight re­
ported a lower rate.30 Almost all private duty
nurses received the same pay for night as for day
work. Extra pay for night work was most com­
mon in industrial nursing, doubtless because of
the widespread practice of shift differentials for
plant workers in industry. Of those industrial
nurses required to work late shifts, three-fifths
reported extra pay for night work (table 19).
Typically any premium rates paid for night
work for institutional nurses were less than 5
percent above the hourly rate for the day shift.
The premium for industrial nurses was usually
higher.
Although the requirement of night work was
not a leading grievance, lack of a higher rate for
night work in institutional work was the subject
of some adverse comment. A few participants in
the study expressed the belief that some nurses
would be willing to work continuously on late
The same monthly pay for longer hours.




shifts if they received a higher rate for this work.
Single nurses or any who work the 8-11 or 11-7
should have $25 to $50 a month more. There would
be many who would be delighted to work those
shifts continually in hospitals—if they received
adequate remuneration.

In institutional work, Southwestern nurses re­
ported extra pay for night work less frequently
and lower hourly rates for night work more often
than those in the rest of the United States;
Pacific Coast nurses reported the highest rates.
There was greater rotation among shifts in
the larger hospitals (those with at least 500 beds);
but, smaller hospitals more frequently paid the
higher rates for night work.
T able 19.—Pay of nurses for night-shift work, 1947
Percent of nurses1
Hourly rate of pay for nightshift work

All Institu­ Private Indus­ Nurse
fields 2 tional duty trial educa­
tors

Lower rate than for day shift___
8.3
‘ 9.4
Same rate as for day shift..........
Higher rate than for day shift _-.
2.3
4.4
Less than 5 percent higher..
7.9
At least 5 percent higher----Total____ ____________ * 00.0
Number of replies to question___ , 1,837

12.7
55.0
32.3
23.0
9.3

2.6
93.7
3.7
1.9
1.8

2.8
35.8
61.4
25.2
36.2

8.0
52.0
40.0
8.0
32.0

100.0

100.0

100.0

100.0

2,566

1,872

254

25

i

1 Excludes nurses who normally do not work at night, but includes both
those who work on night shift only and those who rotate among shifts.
2 Excludes public health and office nurses, but includes data for other
nurses employed in fields not shown separately.

Advance Hours Posting for Institutional
Nurses
Although only a minority rotated among shifts,
for the vast majority of institutional nurses time
on duty typically varied from period to period.
At the time of the study they most frequently
received several days7 advance notice of hours
schedules (generally a week or 10 days) although
a substantial group received no more than 1 day's
advance notice (table 20). There was a good deal
of regional uniformity in practices on this matter.
There was a tendency for the proportion of
nurses whose time on duty changed from week
to week to be somewhat higher among large than
among small hospitals although this variation was
not highly consistent. Among those nurses whose
hours did vary, a higher proportion in the small
hospitals received little or no advance notice of
their schedules.

PART I.
T able

20.—Advance posting of institutional nurses’ hours, 1947

Time for posting hours
Nurses whose hours vary_____________..._______
Hours posted—
The same day..................... . ...........................
1 day ahead.........................-...........................
1 week to 10 days ahead..................................
2 weeks to a half month ahead..... .................
1 month or more ahead....................... _..........
Other advance period.....................................
Nurses whose hours do not vary........................ ........
Total......................................................................
Number of replies to question....................................

Percent of nurses
United New Middle Border Southeast Great
States England Atlantic States
Lakes
80.6
7.3
10.7
47.6
2.2
3.0
9.8
19.4
100.0
4,924

78.6
8.7
11.1
49.2
1.2
.8
7.6
21.4
100.0
485

A higher proportion of Federal employees than
of other institutional nurses reported that their
working periods changed from week to week,
but the vast majority in all types of hospitals
were subject to such changing schedules.

Hours and Earnings in 10 Cities and Hawaii
Among the large cities31 from which the largest
number of replies to the questionnaire were received
the highest hourly rates of private duty nurses
and the highest monthly earnings of institutional
nurses were found in Los Angeles and Detroit;
these cities also had the shortest hours for insti­
tutional nurses—44 hours a week compared with
48 or 49 hours in other cities. Institutional nurses
in Hawaii earned about the same amount each
month as those in Los Angeles but they worked
about 4 hours longer each week. Private duty
nurses in almost all cities were typically on 7%- or
8-hour daily schedules although there were excep­
tions in a number of cities.
Baltimore, Boston, Chicago, Cleveland, Detroit, Los Angeles, New
York, Philadelphia, Pittsburgh, and Washington. The number of replies
from each city was relatively small, so that conclusions presented here should
be considered as only tentative.

784041°—48---- 5




25

ACTIVE NURSES

81.1
9.0
12.2
46.1
1.5
3.2
9.1
18.9
100.0
1,139

82.2
7.9
6.4
52.5
2.9
3.8
8.7
17.8
100.0
343

82.1
11.0
10.6
45.5
2.9
4.4
7.7
17.9
100.0
273

82.2
6.9
12.4
47.2
2.4
2.5
10.8
17.8
100.0
1,301

Middle
West
76.3
8.5
9.8
45.8
.6
2.5
9.1
23.7
100.0
317

South­ Mountain Pacific
west
79.1
7.0
7.5
47.2
5.0
1.0
11.4
20.9
100.0
201

84.9
5.9
11.9
49.8
4.3
2.2
10.8
15.1
100.0
185

77.8
2.6
7.9
47.9
2.5
5.4
11.5
22.2
100.0
680

The lowest private duty rates, usually 85 and
87.5 cents an hour, were found in Boston; in all
other cities except Cleveland, Detroit, and Los
Angeles, where rates were higher, the predominant
rate was $1. Philadelphia institutional nurses,
however, apparently had lower monthly earnings
than those in Boston. Provision of meals for
both institutional and private duty nurses was
common in eastern cities, but unusual in Great
Lakes and Pacific cities.
In all cities except Los Angeles and in Hawaii,
most of the institutional nurses who worked
overtime stated that they received no compensa­
tion for this work. Payment of time and a half
for overtime appeared to be a little more common
in Detroit and Washington, D. C., than elsewhere.
Premium pay for night work was apparently
most usual in Baltimore, Washington, Pittsburgh,
and Los Angeles, and least frequent in Boston.
Time on call was reported by a somewhat
higher proportion of nurses in Philadelphia,
Pittsburgh, and Boston than elsewhere. Split
shifts were reported by more hospital nurses in
these cities and in Baltimore, Washington, and
Hawaii than in the other five large cities studied.

Chapter 3. Living Arrangements and Maintenance
Allowances

Traditionally a large proportion of institutional
nurses and nurse educators have lived in hospital
quarters, frequently without the right to choose
other living arrangements. Accordingly, the
basic salary in these fields is still frequently set
for those occupying such quarters, any additional
pay to those living outside being considered an
allowance in lieu of maintenance. To what extent
does the occupancy of hospital quarters continue
today, and what allowance do those who “live
out” receive for room and board? To what extent
are living arrangements optional, and what sort
of living quarters are provided in hospitals?

Living Arrangements
Those living in hospital quarters comprised
about one in five institutional nurses, about one
in three nurse educators, and one-eighth of all
nurses. The vast majority of both institutional
nurses and nurse educators either were required
to five outside hospital quarters or had a choice
T able

of living in or out; however, a substantial minority
of those who had a choice stated that they received
no allowance for maintenance.
Half the institutional nurses and two-fifths of
the nurse educators reported that they had a choice
of living in or outside the hospital, and of these
the great majority lived in their own quarters.
Another one-third of the members of both fields
were required to live outside (table 21.) A
distinctly higher proportion of nurse educators
than of institutional nurses were required to
occupy hospital quarters, probably because nurse
educators are typically employed in hospitals
that have homes for student nurses and are
frequently responsible for supervision of these
homes.
The group of institutional nurses who were
required to live in is somewhat smaller than the
group who lived in through choice; presumably the
relatively small allowance provided many nurses
in lieu of maintenance and the shortage of housing
help to explain the preference of these nurses for
hospital quarters. However, somewhat fewer

21.—Living arrangements of institutional nurses and nurse educators, 1947
Percent of institutional nurses

Living arrangements

Percent
of nurse
educa­
tors,
United New Middle Border South­ Great Middle South­ Moun­ Pacific United
States England Atlantic States east Lakes West west
tain
States

9.6
Living in hospital quarters required...........................
Living outside hospital quarters required.................. 36.6
Option of living in or outside hospital quarters......... 53.8
Living in................................................................... . 13.0
Living out................................................................. 35.9
4.9
Actual arrangement not reported.........................
Total.............. ............................ .......................... 100.0
Number of replies to question__________________ 4,909

26




11.2
21.6
67.2
17.5
44.6
5.1
100.0

5T

8.9
30.1
61.0
15.4
40.9
4.7
100.0
1,138

16.1
16.4
28.9
22.4
61.2
55.0
21.4
19.9
30.6
36.6
3.2
4.5
100.0 100.0
336~
ST

7.4
43.1
49.5
10.0
34.2
5.3
100.0
1,293

9.3
13.7
48.8
40.6
41.9
45.7
14.7
11.7
24.0
29.9
3.2
4.1
100.0 100.0
wT
3L3~

10.4
40.5
49.1
6.9
36.4
5.8
100.0

6.3
47.6
46.1
6.0
34.3
5.8
100.0
687"

20.5
36.0
43.5
14.1
26.3
3.1
100.0
419

PART I.

27

ACTIVE NURSES

Allowance for Living O ut88

nurse educators lived in through choice than
because they were required to do so.
The proportion of nurses who resided in hospi­
tals, both from choice and because of hospital
regulations, was higher in the eastern and southern
sections of the country. The number of hospital
nurses living in varied from more than one-third
in the Border and Southeastern States to oneeighth on the Pacific Coast. A distinctly lower
proportion of nurses in the East than elsewhere
were required to live outside.
The highest proportion of institutional nurses
required to live in hospital quarters was found
among those in the armed services. A choice of
arrangements was most common in veterans’
hospitals.
The larger hospitals more frequently gave their
nurses a choice of living arrangements than did
smaller institutions; both the proportion of nurses
who were required to live in and the proportion
required to live out was greatest in the smallest
hospitals. Presumably, if these small hospitals
had nurses’ residences, they generally had room
for all the nursing staff and did not offer a choice
of living arrangements.

The extent to which nurses exercised their option
of living outside hospital quarters is presumably
related to some extent to allowances provided them
in lieu of maintenance. One out of three institu­
tional nurses and two out of five nurse educators
who had exercised the option of living out stated
that they were paid no cash allowance in lieu of
maintenance. The most common amounts pro­
vided for subsistence were $20 but less than $50
a month (table 22). Comments like the following
complained about the size of the allowance, a
major grievance of institutional nurses.
My home-town hospital allows only $10 for institu­
tional nurses living outside the hospital. For married
nurses this means one meal and uniform laundered
plus $10. Who can get a room and two meals a day
for $10 a month? Married nurses cannot leave their
husbands to live in the nurses' home.
w These allowances we included in the cash earnings reported in ch. 2. In
order to limit replies to those cases where a clearly distinguishable allowance
was likely to be paid, data were obtained only from nurses employed in
hospitals that provided some living quarters. Presumably, where the
hospital provided no quarters, the allowance for maintenance would not be
clearly separated from the regular salary.

T a b l e 22.—Monthly cask allowances1and maintenance2 'provided institutional nurses who lived outside hospital quarters, 8 1947
United States New England

Middle
Atlantic

Border States W ' |

MidLakes West 4 South­ Moun­ Pacif­
west 4 tain 8 ic 8

Percent of nurses receiving—

Monthly allowance

No
No
No
No
No
No
No
mainte­ Meals mainte­ Meals mainte­ Meals mainte­ Meals Meals mainte­ Meals Meals Meals mainte­ mainte­
nance8
nance8
nance8
nance8
nance*
nance8 nance8
41.6 25.0 15.5
58.4 75.0 84.5
1.7 2.9
1.7
6.6 16.5 15.5
11.9 25.8 15.5
14.5 14.6 15.5
6.9
14.0 10.2
8.6 4,5 27.7
.5
1.7
1.1
Total___________________ 100.0 100.0 100.0
58
579 617
Number of replies to question.......
No cash allowance_____________
Cash allowance________________
Under $10_________________
$10 and under $20......................
$20 and under $30.....................
$30 and under $40......................
$40 and under $50......................
$50 and under $75......................
$75 and nvp.r _
_______

25.9
74.1
2.5
11.1
35.9
8.6
12.3
3.7
100.0
81

32.5
67.5
.8
2.3
16.3
20.9
13.2
13.2
.8
100.0
129

i These allowances have been included in the earnings shown elsewhere
in this report.
aIn addition to salary and cash allowance.
* Limited to nurses employed by institutions that provide living quarters
for some nurses.




21.6 42.5
78.4 57.5
2.3
11.9
3.8
27.0 19.3
16.5 11.5
11.9
3.8
8.3
3.8
.5 15.3
100.0 100.0
26
218

18.8
81.2
2.1
18.8
41.6
8.3
8.3
2.1

16.4
83.6
1.8
30.9
30.9
10.9
7.3
1.8

46.5 29.9 24.1 48.2
53.5 7fr 1 75.9 51.8
2.3 4.2 6.9
9.9 16.7 34.6 18.5
14.5 18.3 17.2
10.5 24.2 6.9 ‘"’ias*
12.2 4.2 6.9 14.8
4.1 2.5 3.4

100.0 100.0 100.0 100.0 100.0
48
55
172 120
29

3.7
22.2
29.6
3.7

57.4
42.6
.8
4.0
4.0
10.5
18.5
4.8

100.0. 100.0
27
27

100.0
124

40.8
59.2

4 Insufficient number reporting no maintenance to justify presentation of
data,
*Insufficient number reporting meals to justify presentation of data.
8 Or only laundry of uniforms,

28

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

Type of Room Provided

single room or an apartment of their own (table
23). Single rooms were least common in the
Southeast, where a relatively high proportion of
nurses were required to live in quarters furnished
by the institution in which they were employed.
Less than two-thirds of the hospital nurses in this
region occupied single rooms.

Generally, those who occupied hospital quarters
were provided single rooms; however, some of
those who shared rooms had to share with two or
more persons. Altogether four out of five insti­
tutional nurses living in hospital residences had a

T able 23.— Type of room provided institutional nurses living in hospital quarters, 1947
Percent of nurses in—
Type of room provided
Single room or apartment not shared with another...........
Double room...................................... ....................................
Room shared with more than 1 other..................................
Total______ ___________ ____________________
Number of replies to question_______________________
1Includes data for regions not shown separately.




United
States 1
81.8
16.0
2.2
100.0
905

New
England
88.1
8.5
3.4
100.0
118

Middle
Atlantic
82.6
16.5
.9
100.0
230

Border
States
76.4
21.6
2.0
100.0
102

Southeast
64.4
31.0
4.6
100.0
87

Great
Lakes
84.5
12.7
2.8
100.0
181

Middle
West
87.3
12.7
100.0
63

Pacific
83.4
12.1
4.5
100 0
66

.

Chapter 4 Paid Vacations and Sick Leave

Except for those on private duty 33 at least
19 out of 20 members of each field of nursing
received paid vacations, typically amounting to
2 weeks or more annually. Four out of five were
allowed sick leave after a year's service. Onefourth of all vacations were 4 weeks or a month
long (table 24) and vacation provisions were gen­
erally considered satisfactory.
T able

24.—Annual paid vacations of nurses 1 after 1 year's
service, 1947

Length of annual paid
vacation
Nurses receiving paid vaca­
tion.........................................
1 week_________ _____
2 weeks...............................
3 weeks................................
4 weeks or 1 month_____
Over 1 month............ ......
Other period................... —
Nurses receiving no paid va­
cation . _
Total________________
Number of replies to ques­
tion.........................................

Nurse
All Insti­ Pub­ Indus­
tu­ lic
edu­
fields4 tional health trial Office cators
96.2 95.9 97.2 98.5 95.6 100.0
2.9
10.3 10.1 2.5 26.2 14.5
49.9 47.8 39.5 66.3 72.5 30.8
7.3 8.7 8.4 1.5 2.5
8.7
24.0 26.0 33.9 2.5 4.8 51.3
.4
4.2
1.8
.8 6.6
.8
2.1
.5
2.9 2.5 6.3 1.6
3.8 4.1 2.8 1.5 4.4
100.0 100.0 100.0 100.0 100.0
7,435 4,237 1,008

675

750

100.0
380

1Excludes data for private duty nurses but includes data for nurses em­
ployed in other fields not shown separately.

except office and private duty nursing.34 In all
branches 2-week limits on such leave were most
usual, 1 week being the next most frequent single
limit (table 25). Sick leave plans were most
widespread among public health nurses, 19 out
of 20 of whom received such leave. A distinctly
smaller proportion—about three-fifths—of office
nurses than of other nurses stated that they were
covered by formal plans for sick leave after a year's
employment. Since the nurse is frequently the
only employee in the office, many may be covered
by informal arrangements whereby their pay is
actually not reduced by absence for illness al­
though there is no definite advance understanding
to this effect.
T able

25.—Formal paid sick leave provided nurses1 after
1 year's service, 1947

Percent of nurses
Amount of sick leave pro­
vided annually
Nurse
All Insti­ Public Indus­
tu­
edu­
fields i tional health trial Office cators
Nurses receiving paid sick
leave-...................................
1 week_____ ___________
2 weeks—.............................
3 weeks................................
4 weeks or 1 month...........
Over 1 month.....................
Other........ ..........................
Nurses receiving no paid sick
leave.......................................
Total.............................. .
Number of replies to question.

81.0 78.8 95.0 81.7 58.5
13.2 13.8 10.6 12.6 13.0
43.8 44.9 53.5 34.5 25.5
3.7 3.1 4.9 4.1 2.0
5.3 4.5 6.7 7.2 2.3
.9 2.3 8.9 3.0
2.1
12.9 11.6 17.0 14.4 12.7

87.9
16.6
40.0
6.4
9.9
3.5
11.5

Nurse educators had the longest vacations, fol­
lowed by public health nurses and institutional
nurses; very substantial groups (including half
the nurse educators) in all three fields had 3- or 4week vacations, and almost all received at least
2 weeks of vacation annually. Industrial and
office nurses reported distinctly shorter vacations;
a large majority received 2 weeks after a year's
service but the rest received only 1 week. Vaca­
tions of industrial nurses were more comparable
with those of office workers in industry than with
those of most other nurses.
Formal sick leave plans were reported by at
least four out of five participants in every field

The most liberal vacation and sick leave policies
for both institutional and public health nurses
were those of the Federal Government. In the
institutional field, State and municipal govern­
ment agencies ranked next in vacation provisions,
followed by privately operated hospitals; county

« Typically employed by one person for only short periods, private duty
nurses ao not receive paid vacations or sick leave.

84 Informal provisions whereby nurses may be granted vacations and sick
leave at the discretion of their supervisor or employer are not reported here.




19.0 21.2 5.0 18.3 41.5 12.1
100.0 100.0 100.0 100.0 100.0 100.0
5,595 3,371 884 459 299
313

1 Excludes private duty nurses but includes data for other nurses em­
ployed in fields not shown separately.

29

30

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

hospitals allowed the shortest vacations. In
public health work, nongovernmental agencies
ranked next to the Federal Government. While
paid sick leave arrangements for public health
nurses were relatively uniform among different
employers, such plans were distinctly less fre­
quent in nongovernmental than in government
hospitals and were less common in municipal
than in other government institutions.
Vacations and paid sick leave plans were more
common in large than in small hospitals, although
in each size group at least 9 nurses out of 10
received vacations and two-thirds were covered
by sick leave plans. Similarly, vacations tended
to be longer in large hospitals although they were
somewhat shorter in the very largest hospitals
(2,000 or more beds) than in the next size group.
The New England and Middle Atlantic regions
provided the longest vacations and the Pacific




States, with short workweeks, provided the short­
est vacations. Vacations of public health nurses
were relatively short in the Southeast and the
Mountain States. In the Middle Atlantic region,
over two out of five of the institutional nurses were
given 4-week vacations, in contrast with less
than one out of seven Pacific nurses.
Formal sick leave plans for hospital nurses
were least common in the Middle West and most
frequent on the Pacific Coast. Public health
nurses, however, were less frequently covered by
such plans in this region and in most fields fewer
days of sick leave were allowed on the Pacific
Coast than elsewhere.
The longest vacations were reported in Balti­
more, New York, and Philadelphia hospitals and
the shortest in Detroit and Los Angeles, where
earnings were higher and hours shorter than in
the other cities studied.

.

Chapter 5 Insurance, Retirement Provisions, and
Medical Care
Only a minority of professional nurses were
protected by plans for retirement pensions, medi­
cal care, or similar benefits paid for wholly or partly
by their employers. With only one in five nurses
(excluding those on private duty)35 covered by
retirement pension plans, lack of provision for
retirement and employment security was con­
sidered unsatisfactory by more nurses than any
other aspect of their work.
T able

26.—Insurance and retirement plans1 provided
nurses,2 1947
Percent of nurses
Type of plan

Some benefits provided...........
Accident ana health insur­
ance only......................... .
Life insurance only...............
Retirement plans only.........
Accident and health and
life insurance......................
Life insurance and retire­
ment....................................
Accident and health insur­
ance and retirement..........
Accident and health and
life insurance and retire­
ment. __...............................
No benefits provided_______
Total................................
Accident and health insur­
ance provided regardless of
other benefits.........................
Life insurance provided re­
gardless of other benefits—
Retirement plan regardless of
other benefits.......................
Number of replies to question.

Nurse
All Insti­ Public Indus­
tu­
edu­
fields2 tional health trial 2 Office2 cators
28.2 21.3 47.9 62.9 13.4
2.8 2.4 1.6 7.4 2.8
2.7 2.2 1.2 10.8 1.1
16.1 13.4 36.9 »13.0 7.6
.9
.6 13.3
.6
1.7
2.3 1.3 3.9 7.5
.4
.5
.7 2.8 4.4
1.3

24.9
2.0
1.5
16.2
.2
4.0
.5

.7 1.9 6.5
1.3
.1
71.8 78.7 62.1 37.1 86.6
100.0 100.0 100.0 100.0 100.0

.5
75.1
100.0

7.1 4.4 6.9 31.6
8.0 4.8 7.6 38.1
21.0 16.1 44.6 31.4
8,201 4,677 1,174 706

3.2
6.2
21.2
402

4.3
2.5
8.6
797

J Excludes private duty nurses but includes other nurses employed in fields
not shown separately.
2 Paid for in whole or in part by employers.
2 All industrial and office nurses are presumably covered by the Socia.
Security Act.

Only industrial and office nurses come within
the scope of the old-age and survivors insurance
2* This group of nurses is excluded from discussion in this chapter since they
are typically employed for only short periods by one employer and hence were
not provided the benefits under consideration by their employers. More­
over, like most other nurses, they are not covered by the provisions of the
Social Security Act.




benefit provisions of the Federal Social Security
Act,36 although employees of the Federal Govern­
ment and some institutional and public health
nurses employed in State and local governments
are protected by retirement plans. Some non­
governmental employers of nurses have recog­
nized the problem of retirement by establishing
pension plans, but at the time of the Bureau’s
study these arrangements applied to only a
comparatively small proportion of the profession.
Public health nurses ranked next to industrial
and office nurses in the extent to which they were
covered by retirement pension plans, with teachers
of nursing and institutional nurses covered least
frequently (table 26). Two-fifths of the public
health nurses were included in such plans, com­
pared with one in eight of the institutional nurses.
Life and accident and health insurance policies
were infrequently provided except for industrial
nurses (table 27), but about two out of five nurses
received hospitalization, medical care, or periodic
physical examinations. Public health nurses re­
ported hospitalization and other medical benefits
less often than those in other fields (except, of
course, private duty). In the public health field
only one nurse in six reported such benefits. The
extent of provision for medical care did not vary
widely among the other fields although it was most
common in institutional and educational work;
nearly half of those employed in these fields, com­
pared with two-fifths of the office and industrial
nurses, reported one or a combination of these
benefits. Although specific arrangements varied
among mu-sing fields, hospitalization and medical
care were generally more common than physical
examinations.
» Nurses in institutions operated for profit come within the scope of this
act but the number in such institutions is apparently small. Some industrial
nurses are also covered by private pension plans maintained by their employ­
ers. They are also covered by the unemployment compensation provisions
of the Social Security Act.

31

32
T able

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

27.— Hospitalization and medical care1 provided
nurses, 1947
Percent of nurses
Type of plan

Some benefits provided
Hospitalization only............
Periodic physical examination only______________
Medical care only.................
Physical examination and
hospitalization............ .......
Hospitalization and medical
care____________ 1_____
Physical examination and
medical care.......................
Hospitalization and medical
care, and physical exam­
ination.................................
No benefits provided...............
Total
Hospitalization regardless of
other benefits___ ________
Medical care regardless of
other benefits____________
Periodic physical examina­
tion regardless of other benftfitS
Number of replies to question..

Nurse
All Insti­ Public Indus­
edu­
tu­
fields2 tional health trial Office cators
16.6 39.6 41.2
1.3 8.3 1.4
9.1 6.2
.8
.2 1.7 21.3
1.0 1.4
.3
1.6 10.7 2.2
.2 3.7 12.3

47.3
8.0
5.1
3.6
2.2
8.5
5.1

10.5 13.8 3.2 7.6 2.9
59.0 52.6 83.4 60.4 58.8
100.0 100.0 100.0 100.0 100.0

14.8
52.7
100.0

27.0 35.1
26.8 30.5

41.0
7.3
5.4
4.6
1.5
7.7
4.0

47.4
9.6
5.5
3.2
1.8
9.9
3.6

7.1
5.2

28.0 6.8
23.7 38.7

33.5
32.0

21.4 24.7 13.5
8,467 4,840 1,171

18.9 16.3
707 872

27.2
412

1 Paid for in whole or in part by employers.
2 Excludes private duty nurses, but includes other nurses employed in
fields not shown separately.

For institutional nurses, retirement pensions
and other benefits appeared to be most frequent
in the Southeast. Pensions were least common in
the Middle West while hospitalization and medical
care were provided least often in the Mountain,
Great Lakes, and Pacific regions.




Retirement pensions are provided by the Fed­
eral Government to its institutional and public
health nurses. About half of the nurses employed
by nongovernmental and municipal public health
agencies also reported pension arrangements,
whereas only two-fifths of the State nurses and
less than one in three of the county nurses bene­
fited from such arrangements. Nongovernmental
hospitals provided retirement pensions less fre­
quently than other types of hospitals.
Employees of State governments and nurses in
armed service hospitals reported hospitalization
and medical care and physical examinations more
frequently than other institutions. Generally
these hospitals provided all three types of care if
they provided any. Except for those in the armed
services, Federal employees receive no hospitaliza­
tion or medical care.
More of the larger hospitals had retirement
pensions and other insurance and hospitalization
and medical care plans than did the smaller hos­
pitals. Two out of five nurses in the smallest
hospitals, compared with two out of three in the
largest, reported hospitalization, medical care,
or physical examinations or a combination of these
benefits. Moreover, a combination of all three
benefits was more frequent in large than in small
hospitals.

Chapter 6. Professional Expenses
Out of the salaries previously discussed, nurses
must meet certain expenses arising out of their
work. These include payments to nurses’ regis­
tries for placement; annual or biennial State regis­
tration fees required in almost all States from all
who use the title “R. N.” ; laundry, cleaning and
purchase of uniforms when these expenses are
not defrayed by the employer; membership in
professional organizations; and # transportation
expenses of public health nurses during working
hours not paid by their employers.
Expenditures of all nurses for these items aver­
aged $83 for the entire year 1946 although ex­
penses varied among nursing fields and still more
widely among individuals within each field. A
fourth of all nurses spent less than $50 in 1946
and another fourth over $125 annually.
Private duty nurses, who are most dependent
on registries for placement and who must almost
always pay for the laundry of their uniforms, re­
ported the highest average expenses—about $100 a
year—and industrial nurses the lowest—$62.
There was little variation in the average outlay
of institutional and public health nurses, whose
expenses were close to the average for all nurses
(table 28).
In both the private duty and public health fields,
one nurse in seven reported at least $200 in pro­
fessional expenditures in 1946. In contrast, ex­
penses of 1 in 10 private duty nurses amounted
to less than $25; many of these may have worked
part time. Presumably the high expenditures of




some public health nurses were traceable to trans­
portation costs on the job not paid by the em­
ploying agency.
Regional variations were not great in most
fields, although in four of the six fields of nursing
expenses were somewhat lower in New England.
In contrast to other fields there appeared to be
appreciable regional variation in expenses of pub­
lic health nurses—from an average of $69 in New
England to $106~$107 in the Border States and
Southeast.
T able 28.—Annual professional expenses 1 of nurses, 1946
Percent of nurses
Annual expenses

Pri­
Nurse
All Insti­ vate Public Indus­
tu­
edu­
fields2 tional duty health trial Office cators

Less than $25............... 11.7 10.6 9.9 11.1 21.8
$25 and under $50____ 17.0 17.5 11.8 20.3 22.1
$50 and under $75........ 16.6 19.4 13.7 14.2 13.0
$75 and under $100___ 14.9 15.5 14.1 13.2 13.0
$100 and under $125. __ 11.1 11.8 11.1 9.2 8.8
$125 and under $150... 8.3 8.0 10.5 6.9 5.2
$150 and under $175.
6.0 5.6 8.0 5.7 5.5
$175 and under $200... 4.1 3.7 6.4 3.6 3.3
$200 and over_______ 10.3 7.9 14.5 15.8 7.3
Total_________ 100.0 100.0 100.0 100.0 100.0
Number of replies to
question.................... 11,203 4,992 2,389 1,208 769
Average expenses,* all
nurses........................ $83
$101 $83 $62

15.2
18.5
16.4
15.2
11.6
8.2
5.2
2.3
7.4
100.0

6.0
14.0
18.6
19.0
13.3
11.2
5.1
3.3
9.5
100.0

919

430

$75

$90

1Indudes expenses for State registration fees; commissions paid nurses'
registries; laundry or cleaning and purchase of uniforms; purchase of profes­
sional equipment; membership in professional organizations; and cost of
transportation of public health nurses during working hours not paid for by
their employers.
2 Includes data for nurses employed in fields not shown separately.
3 Median.

33

Chapter 7. Duties o f Institutional Nurses
How is the working time of institutional nurses
divided among their duties? In an effort to obtain
a rough answer to this question, each hospital nurse
was asked to report her duties for one day. Although
the information was limited to a single day, it is
believed that enough replies were received to give
a general picture of the relative expenditure of
time on major groups of duties.
Between a fourth and a third of the total hours
of institutional nurses were devoted to clerical
work (excluding nurses’ notes) and to a group of
duties including bathing and feeding patients,
giving back rubs, making beds, taking meals to

patients, answering lights, taking patients to
appointments, and checking linens and household
supplies.
Approximately half their time was spent in
preparing and giving medication, changing dress­
ings, giving aseptic treatments, taking tempera­
ture and pulse, checking medications and supplies,
preparing patients for the operating room, assist­
ing in operations and deliveries, and in super­
vising other nurses, students, and nonprofessional
help. The rest of their day was devoted to taking
nurses’ notes and a variety of “other” duties
(table 29).

* T able 29.—Duties of institutional nurses 1—Percent of time spent on major groups of duties
United New Middle Border
States2 England Atlantic States

Duties
Preparing and giving medication, changing dress­
ings, giving aseptic treatments, taking tempera­
ture and pulse, checking medications and sup­

plies, preparing patients for operating room
Assisting in operations and deliveries
Teaching or supervising students r

__

___________. .. .
Supervising registered nurses
Teaching or supervising nonprofessional workers.
Writing nurses' notes__ _______________________
Bathing and feeding patients, giving back rubs,
making beds, taking meals to patients, answering
lights, taking patients to appointments, checking
linens and household supplies_________________
nieriefl.1 yrnrlr (except nurses’ notes) ....... _
Other duties
___ __ __
Total......................................................................
Numher of replies to question

______ ....

South­
east

Great
Lakes

Middle
West

South­
west

Moun­
tain

Pacific

20.5
11.6
7.6
4.8
7.2
8.3

19.0
10.4
8.4
4.2
4.7
7.6

18.9
9.6
9.1
4.9
6.3
8.0

19.9
13.4
9.4
3.8
9.2
7.5

21.3
14.6
6.2
5.5
9.6
7.8

20.1
11.0
8.0
5.0
7.9
8.4

21.2
14.5
9.6
3.0
6.8
8.8

20.7
13.8
5.2
5.8
10.1
9.3

24.1
12.6
7.6
4.4
7.1
8.9

23.7
12.3
3.5
5.7
6.5
8.8

22.9
7.4
9.7
100.0
4,214

27.8
8.1
9.8
100.0
403

23.7
9.0
10.5
100.0
958

18.7
9.0
9.1
100.0
290

16.9
7.9
10.2
100.0
231

23.2
7.1
9.3
100.0
1,131

25.1
5.1
5.9
100.0
265

18.2
7.5
9.4
100.0
175

22.3
4.8
8.2
100.0
151

22.3
5.7
11.5
100.0
617

* Based on report from each nurse covering 1 day in February 1947.
* Includes data for nurses who did not report region in which they worked.

While more nurses expressed satisfaction than
dissatisfaction with the proportion of time allo­
cated to professional work, there were comments
to the effect that the shortage could be appre­
ciably relieved by assigning nurses only to pro­
fessional work. One respondent commented—
In the face of the present great need for nurses, I
might [return] if I were assured that the work I did was
work that required a trained nurse. During the war,
when my husband was in the service, I returned to
nursing work for 2 years. I found that about 85 perU




cent of the work that I was asked to do as a floor nurse
in a hospital could have been done by untrained
personnel. I feel that if hospital administrators could
be taught to make adequate use of an understaff the
critical problem of hospital care would be helped
greatly.

Another stated that she spent half her time in
clerical work and that patient care was secondary:
I enjoy doing bedside nursing, but feel I spend too
much time away from the patient’s bedside doing
many odd hospital chores that could be done by
laymen.

PART I.

ACTIVE NURSES

Duties of individual nurses varied markedly.
General staff nurses spent an even higher pro­
portion of their time than did all institutional
nurses on such tasks as bathing and feeding
patients, carrying trays, and taking patients to
appointments. Head nurses reported that cler­
ical work (other than nurses’ notes) occupied
1 hour out of every 10 of their time. Time spent
on bathing and feeding patients and similar duties
and on clerical work appeared to be greatest in
the New England and the Middle Atlantic States.
About 30 percent of the time of nurses in general
and tuberculosis hospitals, compared with 25
percent of the time in mental institutions, was
spent on clerical work and such work as feeding




35

and bathing patients. Supervision of nonpro­
fessional help accounted for a large proportion of
nurses’ time in mental hospitals.
Proportionately less time was required for
relatively routine care of patients in large than
in small institutions. However, clerical work
increased in importance with size of hospital;
consequently, there was little variation among
different-sized institutions in the time spent on
these two groups of duties considered together.
Supervision required more time, and assistance in
operations and deliveries accounted for less time
in large than in other hospitals. These differences
are partly traceable to the fact that many of the
largest hospitals are mental institutions.

.

Chapter 8 Opinions3
7
What do nurses think of their work? What
aspects of nursing do they consider most satis­
factory and what aspects are the greatest sources
of complaint? Their opinions regarding their
work were obtained for the light they throw on
potential sources of lowered morale in the profes­
sion as well as on the difficulties of recruiting
student nurses and, to a more limited extent, of
keeping graduate nurses in the profession. (It is
pointed out later that the major reason for gradu­
ate nurses leaving their profession is to marry
rather than because dissatisfaction leads them to
peek other jobs; however, salaries and other work­
ing conditions are a factor in some losses of
graduate nurses.)
A large majority of nurses in all fields expressed
satisfaction with their job as a whole and with
the gratification provided by service to the ill
and to the community (table 30) .38 Nevertheless,
although the sources of complaint varied among
individuals, most were apparently dissatisfied
with one or more aspects of their work. A
number commented that “ there is no other work*
*7 A brief explanation regarding the method used in summarizing opinions
seems desirable since alternative procedures might presumably have been
adopted. Participants in the survey were asked to indicate “satisfactory,”
“unsatisfactory,” “no opinion,” or “does not apply” regarding 26 aspects of
their work. Each percentage in the tables showing opinions is based on the
total number of nurses expressing their attitude on any of the 26 aspects of
their work rather than in terms of the total number expressing definite
opinions of dissatisfaction or satisfaction regarding the specific item in ques­
tion. This procedure attempts to discover the major sources of grievances
in the nursing profession as a whole and in its leading branches, rather than
to determine what proportion of the nurses subject to a given condition were
dissatisfied with it. Exclusion of those expressing “no opinion” or stating
that a condition did not apply would give the second measure rather than
the first. For example, large proportions of institutional nurses working
split shifts considered them unsatisfactory but, because most nurses worked
straight shifts, many considered this item as inapplicable to them and ex­
pressed “no opinion” regarding it; thus split shifts cannot be considered a
major grievance in title profession or in institutional nursing as a whole
although they were a serious source of discontent where they were in effect.
In addition to these quantitative measures of satisfaction, opinions ex­
pressed in supplementary comments of many nurses (at least a thousand in
all) are discussed in nonquantitative terms.
w About 5 percent of the nurses participating in the survey stated that
they had returned to nursing after trying another field of employment.
The dominant reason reported was the greater satisfaction in service provided
by nursing; other reasons were cited very infrequently.

36




like nursing” but that their working conditions
were poor in one or more respects. For example:
I realize very little for my efforts (after expenses)
there is little left and hours long. However, my
great love for my profession gives me sufficient reward
and satisfied my deep desire to nurse.

The leading complaints were related to financial
returns both during nursing employment and after
retirement. Specifically they referred to lack of
retirement and employment security, rates of pay,
opportunities for and methods of awarding promo­
tions.
There was a widespread feeling of insecurity; a
higher proportion of respondents to the question­
naire considered provisions for retirement and
security against unemployment to be unsatis­
factory than any other subject about which they
were questioned. This was the most frequently
mentioned source of dissatisfaction in every field
except industrial nursing, the only branch covered
by both the retirement and unemployment com­
pensation provisions of the Social Security Act.
Office nurses are also covered by the retirement
provisions of the Social Security Act. The
following comments are typical:
On question 13 [provisions for retirement and
security against unemployment] I have checked un­
satisfactory. You may wonder why I have done this
and remained here for 20 years. This sort of work
has been very satisfactory to me. When I came here
1 was young enough not to count the pennies and
having no dependents I’ve sort of drifted along.
Now I realize as far as my social security is concerned
I haven’t any and am waking up too late to change
my job for better remuneration.
Nurses have no unemployment or social security
benefits unless employed in the industrial field. . . .
I think that nurses should have the benefits obtained
by other laborers and professional people.
We need not only adequate pay and shorter hours
but some sense of job security. We are not provided
for by Social Security. We all can see what happens
to the nurse too old or ill to work. She usually works
anyhow.

PART I.

ACTIVE NURSES

At the present, working for a county government, I
come under a retirement fund. If I leave this job I
must start all over with retirement and lose all sen­
iority and if my new position doesn’t have such
benefits I’m just out of luck.

Related to lack of provision for retirement was
lack of adequate care for those who become
disabled.
Nurses who contract TB, infantile paralysis, or
become permanently disabled are not taken care of
(except for 13 weeks).

Next to the problem of insecurity were other
issues revolving about rates of pay, including
maintenance allowances provided institutional
nurses and nurse educators who live outside
hospital quarters, and opportunities for and
methods of determining promotions and pay in­
creases. Although on each of these issues expres­
sions of satisfaction and “no opinion,, together
exceeded dissatisfaction in most or all fields, those
who were definitely dissatisfied were numerous
enough to indicate the existence of serious prob­
lems. Indeed, while the widespread lack of pen­
sion plans in the profession caused more nurses to
check this than any other item as unsatisfactory,
comments of participants indicated that rates of
pay were an even more serious and immediate
cause of discontent. Lack of provision for retire­
ment or illness and salaries that do not permit
nurses to save toward retirement or for emergencies
were frequently mentioned together.
In this community at least, there are no assurances
for any old age security for a woman who has spent
her lifetime at nursing and the provisions for the sick
nurses are either pathetically meager or nonexistent.
On the hand to mouth existence of trying to make
ends meet there is no opportunity of accumulating
any savings to take care of these emergency needs.
Apparently nurses are still expected to live on and
save for their old age, on the personal satisfaction they
obtain from taking care of patients.
. . . After many, too many, years spent in nurs­
ing I, for example, am attending night college at pres­
ent with the firm intention of preparing for some kind
of work that will enable me to be assured of something
better than the County Home after a lifetime of
nursing.
As it stands today, nursing offers only enough to
cover the bare essentials of living with no chance to
save for the future or for emergencies . . . . It is
obvious that a nurse cannot live on the gratitude of
patients; she must have sufficient income.

Other comments regarding salaries simply




37

stated that they were inadequate to meet the
nurses' needs.
As an R. N. I wish to serve humanity to the best of
my knowledge and ability without any personal recog­
nition. However, a nurse needs to make a salary
which enables her to meet the cost of living and
necessities expected of a professional woman without
lowering the standards of the profession by unionizing.
After paying tuition for 3 years’ training and not
receiving any pay (except for the time we belonged to
the Nurse Cadet Corps), a nurse should be paid
enough after she graduates to make a fairly decent
living and save a little money. No matter how great
the satisfaction of serving mankind thru nursing may
be—the high cost of living cannot be met with that
satisfaction alone. One needs cash, and nurses should
be getting more of it.

Still other comments compared nurses' earnings
with those of other professional groups and of
industrial workers and nonprofessional hospital
workers.
We can work as waitresses, factory workers, and
many other jobs which do not require 3 years’ training
and yet offer many advantages. They are protected
by strong unions that demand higher wages, no over­
time without pay, easier work, provide hospitaliza­
tion, health insurance, and old-age benefits, and
protect the worker in general. This is your reason
for the nurse shortage . . . . I personally plan to
try for another 6 months Or so to find a nursing posi­
tion in which I cannot only be proud of my profession
but also can earn enough to live comfortably. If I
cannot do this, I will do as hundreds of my colleagues
have done and take advantage of my GI educational
rights, go to college and provide myself with an en­
tirely new profession or type of work that will give an
even chance for comfortable living. We do not ask for
more.
I have found that the maids and janitors make more
or equal salary to the registered nurse. Many nurses
have left the profession because of being underpaid for
strenuous overtime labor and always with the same
story of being short of help; thereby having to do more
work than a human can possibly stand. I feel the
same way, as soon as I can prepare myself for some
other type of work will be changing.
The practical nurse gets $7 for each 8 hours while a
registered nurse makes only $8 for each 8-hour shift.
Yet a registered nurse is expected to pay dues and
assume all responsibilities.

In their criticism of methods of awarding pro­
motions, many nurses objected to the emphasis
placed on graduate nursing education and stated
that those interested in “bedside” nursing rather
than administrative work were at a disadvantage
in salary and prestige.

38

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES
T a b l e 30. — Opinions
Subject

Hourly rate of pay............................................................................
Allowance for living outside hospital_____________________
Fees paid registry for obtaining job__________ ____________
Length of workday and workweek_________ _____________
Advance notice of hours schedule__________________ _____
Amount of time on call_______________ _______ ______ ___
Split shifts.........................................................................................
Requirement of night-shift work...................................................
Privacy of room in nurses’ home____________ ____________
Freedom of movement in nurses’ home......................................
Locker and rest room facilities............. ..................................... .
Number and arduousness of duties.............................................
Timing of duties...............................................................................
Proportion of time on professional duties.....................................
Opportunity to exercise professional judgment...........................
Nonprofessional help................... ...................................................
Quality of supervision.....................................................................
Opportunities for promotion_________ ____________ ______
Methods of determining promotions and pay increases.............
Procedures for settling grievances and making suggestions for
changes in procedures...................................................................
Educational opportunities..............................................................
Paid vacation provisions....................................... ............. ..........
Retirement and employment security.-.....................................
Pride or gratification in service to ill and community.......... .
Professional and social contacts and status................................
The job as a whole................................................. .........................
Total number of nurses expressing opinions on any sub­
ject........................................................................................

of nurses regarding their work, 1947

Percent of institutional nurses Percent of private duty nurses Percent of public health nurses
expressing—
expressing—
expressing—
Dissatis­ Satisfac­ No Dissatis­ Satisfac­ No Dissatis­ Satisfac­ No
faction
tion opinion * faction tion opinion 1 faction tion opinion *
46
35
6
33
16
7
21
13
7
8
39
27
32
28
21
53
26
41
48
41
28
17
55
14
24
20

38
18
13
56
63
27
22
32
29
28
30
50
49
46
64
30
55
30
27
39
40
69
22
62
54
64
5,237

16
47
81
11
21
66
57
55
64
64
31
23
19
26
15
17
19
29
25
20
32
14
23
24
22
16

(*)

31
15
23
12
6
14
10

(*)
(*) 36
6
7
14
12
32
17
15
18
24
13
11
48
7
14
13

57
<*) 46
51
23
34
7
26
<*)
(*) 19
31
23
28
51
12
26
6
9
15
22
7
3
55
48
60
2,429

(*)

12
39
26
65
60
79
64

(’)
(*) 45
63
70
58
37
56
57
79
73
61
65
82
49
38
38
27

32
(*) 2
8
2
3
1
1
(*)
(*) 8
10
13
11
8
17
15
28
33
20
14
11
37
6
11
6

(2)

(*)
(*)

35
4
74
34
23
2
4
12
45
48
49
74
30
56
37
40
51
62
72
44
72
70
82

33
<*) 94
18
64
74
97
95
(»)
(*) 80
45
39
40
18
53
29
35
27
29
24
17
19
22
19
12

1,249

See footnotes at end of table.

In order to advance professionally at the present
time, you must sacrifice doing actual bedside nursing.
To me this is robbing me of one of the best and most
enjoyable parts of my work.
Don’t misunderstand me, I am not for lowering the
standards but something must be done; we can’t all
be teachers and if anyone wants to go on it’s the thing
to do and let those who would care for the sick alone
to do it. As it is, unless you have been to teachers
college or some other, you can’t do much in nursing.
Too much stress is placed on degrees. My experi­
ence has been that many nurses who have degrees do
not want to do any of the menial duties in connection
with nursing and yet there are not enough positions
for nurses with degrees. The degree nurse, in many
cases, is not a good instructress. Even though she
has a degree, she is unable to intelligently instruct
the students. We cannot all be executives—there
must be some of the common people. The old pro­
verb is so true: “God must have loved the common
people because he made so many of them.”
As a former nursing arts instructor I think nursing
schools have placed too much emphasis on mere
scholastic ability, and have tended to forget the im­
portance of good bedside nursing. For that reason
* students were often disqualified because they could
not cope with the vast mass of theoretical and often
useless material included in the course of study. I
think, too, that too little recognition has been given
to the general duty nurse who is actually the back­
bone of the nursing profession, just as the laborer is the




backbone of industry. The recognition could have
been not only monetary, but shall I say psychological
in that general duty nurses could have been more
publicized as the key nurses of the profession. Yet
recognition is given mostly to the nurse who “goes to
college” or who takes a post-graduate course, when
each of these may be mere gestures of “ambition”
and not necessarily denote interest or ability as
nurses.

There were other problems of concern to large
groups of nurses although they did not affect all
branches of the profession. Among the leading
sources of dissatisfaction in several fields were
locker and rest-room facilities, the quality and
quantity of nonprofessional help, and procedures
for settling the grievances that inevitably arise
in large (and many small) institutions. In con­
trast to these complaints, there was fairly general
satisfaction with such aspects of their work as the
amount of advance notice of hours on duty and
with paid vacations and, as indicated earlier, with
community service and the job as a whole.
In many cases, expressions of opinions regarding
the 26 aspects of their work about which partici­
pants in the survey were specifically asked were
supplemented by comments. Some of these re­
ferred to aspects of work not mentioned in the

PART I.
T able

39

ACTIVE NURSES

30.—Opinions of nurses regarding their work, 1947—Continued

Subject
Hourly rate of pay............................................................................
Allowance for living outside hospital............................................
Fees paid registry for obtaining job...............................................
Length of workday and workweek................................................
Advance notice of hours schedule..................................................
Amount of time on call. .................................................................
Split shifts.......................................................................................
Requirement of night-shift work..................................................
Privacy of room in nurses'home
_ _ _ _ _
Freedom of movement in nurses’ hom e......................................
Locker and rest room facilities...... ............... ................................
Number and arduousness of duties...............................................
Timing of duties...............................................................................
Proportion of time on professional duties.....................................
Opportunity to exercise professional judgment............................
Nonprofessional help........................................................................
Quality of supervision.......... ...........................................................
Opportunities for promotion...........................................................
Methods of determining promotions and pay increases.............
Procedures for settling grievances and making suggestions for
changes in procedures..................................................................
Educational opportunities............... ..............................................
Paid vacation provisions.................................................................
Retirement and employment security—. ....................................
Pride or gratification in service to ill and community...........—
Professional and social contacts and status..................................
The job as a whole............................................................................
Total number of nurses expressing opinions on any sub­
ject........................................................................................

Percent of industrial nurses Percent of office nurses express­ Percent of nurse educators ex­
pressing—
expressing—
ing—
Dissatis­ Satisfac­ No opin­ Dissatis­ Satisfac­ No opin­ Dissatis­ Satisfac­ No opin­
ion 1 faction
faction tion
tion
ion i
tion
ion 1 faction
27
4
5
3
1
5
. 4
0
0 13
5
7
11
6
10
11
23
29
18
16
9
23
6
11
4
0

0

0
0

58
8
81
43
19
10
21
44
60
55
53
76
34
51
34
39
50
36
80
52
61
62
86

0

15
88
14
54
80
85
75

0
(2) 43
35
38
36
18
56
38
43
32
32
48
11
25
33
27
10

29
(2) 6
17
4
2
6
2
0
0 8
8
10
13
8
12
5
19
25
12
12
11
29
6
8
7

798

50
0 9
68
23
12
4
6
0
0 18
46
41
44
67
26
31
18
25
38
40
68
26
60
66
80
938

21
0 85
15
73
86
90
92
0
0 74
46
49
43
25
62
64
63
50
50
48
21
45
34
26
13

29
30
4
20
7
5
7
1
7
7
31 •
25
27
19
19
46
32
25
44
39
20
15
59
16
24
15

48
17
8
72
59
20
17
10
35
37
30
55
52
59
75
25
43
51
38
50
68
81
25
65
69
77

23
53
88
8
34
75
76
89
58
56
39
20
21
22
6
29
25
24
18
11
12
4
16
19
7
8

438

1Includes those to whom the item did not apply as well as those expressing no opinion.
*Not applicable.

questionnaire; a few of the more frequently
expressed viewpoints are summarized in the
following paragraphs.
Several aspects of student training were cited as
deterrents to entrance into and completion of
training and to the development of competent
nurses. These include:
(а ) Supervision
Schools of nursing are run with fear as the basis;
fear of doing something wrong, fear of being expelled
for unimportant things, and actual fear of the director
herself instead of respect and admiration.
Student nurses are treated as stupid individuals,
with little or no sense. Till adjustment is made in
these matters few students will take nursing as a pro­
fession.

(б ) Regulation of students1personal lives
Students have been too restrained for normal girl­
hood in most training schools and so quit training.
One more thing in behalf of students: While I
heartily approve of discipline to some extent, I
see no reason why a nurses training school has to be
managed like a nunnery or treated like the enlisted
men were in the army, as though they do not even
come from the same class of women as graduates. If




there weren't so many nagging old maids running
training schools there would be more students in
them. I am not so young and have been a nurse a
long time, but I feel I have never allowed my profes­
sion to deteriorate my interest in the younger nurses,
nor do I think that we were so much better than the
new graduates.

(c) Lack of recreational facilities for students
(d) Length of the training period
Some argued that the training period is too
long, whereas, others believed that nurses could
be better trained in the time they spend on their
basic nursing education. One stated:
Perhaps there should be a graded R. N. one-, two-,
and three-year courses.

Another wrote:

Nurses should be trained more efficiently in cer­
tain fields of nursing before graduation. Why should
any graduate nurse have to take postgraduate work,
for special fields except administrative work? The
average intelligent girl doesn't have to spend 3 years
learning ordinary nursing care and management.

(e) Students being required to work too hard and to
perform tasks nonprofessional help could do

40

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

I am not experiencing any difficulty in this position
(except salary), but my training was one of extreme
hardship, and I frequently wonder how I survived.
Aspects which make nursing disagreeable to the
prospective student: (1) too many restrictions on
liberties, little privacy, need for being in most of the
week, if permitted to be out, only until 10 p. m. or
11:30 p. m. once a week and being allowed to have
only one overnight at home a month; (2) too many
courses crowded into too short a period of time which
makes it necessary for the student to study most of the
time and gives little opportunity for a social life; and
(3) tendency for hospitals to depend upon students
for most of the patient care which makes the load of
work carried by the student too heavy.

(/) Lack of pay to students and high expenses
The cost of entrance fees for tuition for student
nurses is too high. Hospitals should return to the
method of prewar years—charging only for books and
uniforms. Many young high school graduates of
today would make excellent students and future
nurses but do not want to pay the high tuition rate—
and in addition to be without funds for spending
money for 3 years or the training duration. The old
method of allowing a monthly sum helped to keep
student nurses. Also—many parents do not have
the necessary funds to give the hospital. As a result
their young daughter (who really wanted to be a
nurse) takes an ordinary office job—and probably
goes to night school for additional education.
They [students] do not receive enough pay. I
trained in 1939 to 1942—I received $2.50 a month,
worked many hours over in a day lots of times.

(g) Poor selection of students
We need better qualified superintendents of nursing
schools. We need the superintendent who has vision
to know and recognize the qualities in an applicant
which will make her a good nurse. Too many nurses
are permitted to continue their training in order only
to staff the hospital, but to find at the end that they are
not particularly adapted to nursing.

Frequent complaints were voiced regarding the
frequent inability of nurses trained and registered
in one State to meet the qualifications in other
States without taking examinations or indeed
without additional education.
One reason there is such a critical shortage of nurses
in our country is that the different States have differ­
ent qualifications for a graduate nurse to get registered
in their State and some of we graduate nurses can't
meet these qualifications and, therefore, if we move
from one State to another, we are forced to sit on the
sidelines or go to a hospital and take postgraduate
work in order to meet with the State requirements, in
which you reside, in order to get registered so you can




work. There are nurses like myself who are married,
but would be willing to work and help out, but live in
States where they are unable to get registered, unless
they take postgraduate work.
How about national registration for nurses, espe­
cially the service nurse.

Variation Among Nursing Fields
It is not easy to rank each field of nursing accord­
ing to the general extent of dissatisfaction since
some items that were major sources of discontent
in one field were, at most, minor problems in
others. However, institutional nurses were quite
clearly the most dissatisfied group and the next
most dissatisfied appeared to be nurse educators
and private duty nurses. Discontent was dis­
tinctly less marked among public health nurses.
They in turn seemed to be somewhat more critical
of their working conditions than doctor’s office or
industrial nurses although the differences were not
great, but there were items on which they
expressed less dissatisfaction than the nurses in
these two fields. Chart 4 compares opinions of
nurses in the various fields of nursing on four
aspects of their work.
Industrial, Office, and Public Health

Nurses employed in industry were generally
most satisfied with their work. Thus, a larger
proportion in this field than in any other were
satisfied with their job as a whole and the length
of their workday, and their opportunities to
exercise professional judgment. Definite expres­
sions of dissatisfaction in this field were about
equal to those of office nurses, but distinctly higher
proportions of industrial nurses expressed definite
satisfaction; large numbers of office nurses voiced
no opinion on many items.
Public-health nurses expressed greater pride in
service to the ill and the community than any
other group. Moreover, four out of five were
definitely satisfied with their job as a whole; only
6 percent expressed definite dissatisfaction on this
point.
In all three fields in which dissatisfaction was
least widespread, complaint was largely concen­
trated on grievances common to other branches
of the profession (lack of provision for retirement
and employment security, rates of pay, provisions
for promotions and pay increases, and opportu-

PART I.

ACTIVE NURSES

41
CHART 4

Attitude Of Professional Nurses, 1947
Percent Expressing Dissatisfaction about—
T H E JO B
A S A W H O LE

PR O VISIO N FOR R E T IR E M E N T
AND E M P L O Y M E N T S E C U R IT Y

UNITED STATES DEPARTMENT OF LABOR
BUREAU OF LABOR STATISTICS

nities for promotion). Dissatisfaction with their
rate of pay and with opportunities for promotion
was indeed greater among public-health nurses
than in any other field except institutional work.
Except for the items listed earlier in this para­
graph and the item “Procedures for settling
grievances and making suggestions for changes in
procedures,” no aspect of their work was con­
sidered unsatisfactory by as many as 1 out of 5
public-health nurses; in most cases the proportion
of dissatisfied nurses was no higher than 1 in 10.
Among office and industrial nurses, there was
no item on which definite statements of dissatis­
faction exceeded 30 percent of all replies. Al­
though one in five industrial nurses complained of
retirement and employment security provisions,
this proportion was distinctly smaller than that
in any other field, except office nurses who are
also covered by the retirement provisions of the
Social Security Act.
Private Duty

The marked difference between working con­
ditions of private duty nurses and those of other
nurses, and the resulting high proportion of
private duty nurses who did not express definite
opinions regarding many aspects of nursing, make
comparisons with other fields difficult.39* Never­
theless, it appears that positive expressions of
dissatisfaction in this field ranked next to those




of nurse educators. The leading sources of
complaint were lack of provision for retirement
and security against unemployment, the hourly
rate of pay (major grievances in other branches
of the profession), as well as locker and rest-room
facilities, and nonprofessional help. Employed
as they typically are by individual patients for a
comparatively short period of time, almost all
private duty nurses who expressed opinions on the
subject were concerned with retirement and
employment security.
These war years, one is called before a reasonable
rest period has been taken, but there have been times
when I wondered if I would have to borrow money—
in fact I have done so to live and I’m considered a good
nurse by most doctors.
There is no social security—don’t we get old?
There is no pension—don’t we get sick?
Now I am unable to work because of a back injury
obtained while doing private duty. I have been home
1 month and 2 weeks, and will have to remain at home
from 3 to 6 months. There isn’t any compensation
for nurses, but still I have to live and pay a doctor
two times per week.

39 Data on private duty nurses are omitted from table 30 for items that
clearly do not apply to this field; others that were considered by a substantial
number as applicable are included, even though large groups considered them
as inapplicable. For example, since there is no opportunity for promotion
in the private duty field, many did not express opinions regarding opportu­
nities for promotions and pay increases. On the other hand, some apparently
considered the question to apply to methods used in the community to adjust
the prevailing pay scale for private duty work or considered the inherent lack
of opportunity for promotion in the field to be a disadvantage and, therefore,
replied to the question.

42

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

While there was a good deal of dissatisfaction
with their hourly rate of pay, many private duty
nurses compared it favorably with that in other
branches of the profession. There was some rec­
ognition of the problem of patients paying these
higher rates.
The recent raise in the salary of private duty nurses
seems to have provoked added dissension on the part
of the doctors. I agree that it does make special
nursing prohibitive to those of moderate income,
which is unjust, but it occurs to me that an optional
clause could be added to the present hospitalization
insurance plan whereby, with a small additional pay­
ment, they could be assured nursing care for 2 to 3
days.

There were frequent comments from private
duty nurses that they chose this field because it
allowed them greater personal freedom and better
rates of pay than other comparable fields of nurs­
ing. Many, however, stated that institutional
work proved to be more interesting and provided
greater satisfaction in community service.
I only work at private duty nursing because there is
no better paying nursing position available here, and
because there is such an acute shortage of nurses which
seems to grow more acute as time passes. I do not
particularly like private duty nursing, while I do like
general duty nursing. While in the Army I qualified
as a head nurse or a charge nurse. In civilian life, I
cannot find such a position open in this district.
I returned to do private duty which paid more
money, and in case of emergency I didn’t have to re­
port to work. If I returned to head nursing I would
feel obligated to report on duty even if the baby were ill,
because it would leave the floor in a poorly supervised
Condition.

Nurse Educators

Sharing as they do many of the working condi­
tions of institutional nurses and working closely
with them, nurse educators ranked next in dis­
satisfaction and their main objects of complaint
were about the same.40 Opportunities for promo­
tion, as contrasted with methods of awarding pro­
motions and pay increases, were not a major
source of dissatisfaction among nurse educators.
Although hours were not a leading complaint,

some comments pointed to work that must be
done on the nurses’ own time.
There is not enough understanding by administra­
tors of the amount of time which should of necessity
be given to guidance, individual conferences, etc.
Therefore, it is done on duty time and much lesson
preparation and paper work must be done in off duty
time.

Institutional

The dissatisfaction of institutional nurses ex­
ceeded that of other nurses with respect to almost
every aspect of their work about which they were
questioned. One out of five was critical of her
job as a whole. In addition to the conditions that
were major grievances in almost all branches of
nursing,41 institutional nurses frequently objected
to their duties (unevenness of their work load, the
number and arduousness of their duties, the pro­
portion of time spent on nonprofessional work),
the quality of supervision, their educational op­
portunities, and hours of work. Half of all in­
stitutional nurses who expressed opinions on any
aspect of their job were dissatisfied with the qual­
ity and quantity of nonprofessional help and pro­
vision for retirement and employment security.
Complaints regarding the arduousness of the
work referred both to heavy patient loads and to
the general physical strain of nursing.
At times it requires a strong, large nurse to lift the
heavy patients—and the transporting of heavy equip­
ment and oxygen tanks. It is hard work and there
are never people available to lift these things. It is
much easier to turn to a different position than to suf­
fer these strains.
Work is very heavy everywhere. Everyone leaves
the floor with the feeling that his work is incom­
plete—if one stayed 2 hours longer the feeling would
still be the same.
Our hospital tries to be fair. Our vacations are a
month after 3 years of service. However, there are
never extra nurses put on duty during vacation time.
Both the nurses and patients suffer as a result of
overload on the nurses. We are not allowed rest
periods either during the morning or afternoon. It
seems any worker should have at least 15 minutes’
relaxation during each 4 hours of work. I don’t feel
nor do many nurses feel that with their training and
experience they could find contentment in any other
profession.

40 Their major complaints were provisions for retirement and employment
security, the quality and quantity of nonprofessional help, the quality of
supervision, methods of determining promotions and pay increases, hourly
41 Retirement and employment security provisions, salaries (including
rate of pay (including allowances for living outside hospital quarters), locker
allowances for living out), promotional opportunities and methods, pro­
and rest room facilities, the number and timing and arduousness of their
cedures for settling grievances, nonprofessional help, and locker and rest
duties, and procedures for settling grievances.
room facilities.




PART I.

ACTIVE NURSES

You work like a demon wondering why you
couldn’t be an octopus and a centipede at the same
time. You stay on duty until everything is com­
pleted and if you punch the clock an hour or more
late it apparently is your own fault for not being
able to plan your work better. Our time clock seemed
to be installed as a means of checking on the time we
reported for duty but the pay-roll department blind­
folded their eyes and their conscience to any overtime.

Poor supervision and lack of consideration and
treatment as professional nurses on the part of
hospital administrators, doctors, and the public
were commented on frequently.
Executives do not give nurses the consideration they
should have. We are just machines, our suggestions
are of no value whatsoever. . . . Being an ex-Army
nurse and familiar with the “suggestion box,” I be­
lieve such a plan would be welcome at a large hospital
such as the one I am employed by. A nurse can see
many times (being right with the patient), just what
changes might save work, and at the same time can
see what might help to make the patient happy and
contented. At our hospital no suggestions are taken
whatsoever from a nurse.
[Nurses] dislike their supervisors—(1) because they
show favoritism, (2) if a nurse makes a mistake or
does something wrong she is told about it, in front of
doctors, patients, and others, and corrected in such a
way that she is made to feel like a moron. The
varied salaries for staff nurses—not depending on the
number of years you worked at the hospital, or the
type of nurse you are—but upon whether you are a
favorite or not.
I would suggest that a carefully picked director of
personnel would be a great factor in relieving many of
the difficulties which I have encountered.

A private duty nurse enumerated her reasons
for leaving:
(1) more patients per nurse assigned than could
be cared for adequately. This situation had existed
for many years prior to the war; (2) additional duties
added to an already impossible load . . .; (3) super­
visors who criticized nonessentials or overlooked
proper care of the patient; and (4) head nurses with
slave-driving tactics.
. . . years ago some one had thought ahead and
I feel a little more understanding and little more
kindness and consideration from doctor, hospital
executives and also from private individuals, would
have prevented the present shortage of nurses. Don’t
get me wrong, in my quarter of a century of nursing
I have had more good than bad but surely hope the
nurses of the future have a life with more time for
fun and play and normal living, that she won’t be
considered a queer duck because she works nights, etc.
The daily load carried by each nurse is so heavy
that of necessity minor details are neglected that the




43

important things might be done for the patient.
Instead of receiving the slightest bit of encouragement
from the people that sit in the office and make rounds
very infrequently, these small things are criticized
and the nurse, who is overworked physically as a
result, tense mentally, is made to feel that she is doing
nothing.
People expect nurses to be more or less like a high
classed servant, instead of giving them the status of
an actual profession.
Doctors do not treat nurses with professional cour­
tesy. Many doctors tell a patient that the nurse
should do so and so, walk off without writing an order
for it and expect orders carried out on the patient’s
saying the doctor ordered it. Doctors (a large per­
centage) do not treat a nurse as though she had any
professional background. They don’t give her credit
for knowing how things are to be done. Nurses are
supposed to do as they are told and not allowed
to use an initiative of their own. Many patients treat
a nurse as though she were a servant instead of some­
one with special training.

Allied to criticism of poor supervision was
objection to being transferred from ward to ward
in a seemingly arbitrary manner.
One other aspect that is a source of dissatisfaction
to nurses, is the attitude that a nurse can be placed
anywhere in a hospital at any time with a total dis­
regard to any special training she may have had,
e. g., the placing of a surgical nurse on a medical
ward to suit the convenience of the one that makes
out the work schedule. A nurse that has spent many
years making herself a good surgical nurse is placed
at a distinct disadvantage when placed in a medical
ward, she knows herself to be inadequate for the job
which adds considerably to the mental strain under
which she will work and at the same time does not
provide the patient with the type of care to which he
is entitled. In all other professions and trades special­
ties are recognized and respected, but a nurse is ex­
pected to be a “jack of ail trades.”

There were a few complaints of dismissal
without notice or opportunity for hearing. One
example is quoted here.
Due to a dispute with an interne, the writer was
confronted with a 30-minute notice which was placed
on her dresser, stating that her services were no longer
required, and furthermore, given no opportunity of a
hearing to state the facts and circumstances involving
said dispute. The action was not justified when you
consider the hospital ruling, whereby 30 days’ notice
must be given if you choose to leave on your own
volition—with a stipulation one must continue on
over the notice period if necessary until a successor
is available.

Because most institutional nurses do not work
split shifts, this type of schedule was not a leading

44

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

cause of dissatisfaction. However, almost all
those who worked split shifts considered them
unsatisfactory.
The girls are overworked, working a split 12-hour
shift. Oftentimes having to stay on duty, because of
emergency and lack of nursing power.
I found the split shift very unsatisfactory. If you
went out to do an errand or some shopping you were a
nervous wreck trying to get back on duty on time,
about all one could do was get uniforms mended and
in shape and perhaps rest a little, you could never
completely relax for watching the clock.

In addition to the general criticism of the quality
and quantity of nonprofessional help, there was a
good deal of resentment of the status, privileges,
and responsibilities granted practical nurses.
Objection was also voiced to the fact that uniforms
of practical nurses do not distinguish them from
professional nurses, and (as pointed out earlier)
to their earnings as compared with those of pro­
fessional nurses. Despite the time some pro­
fessional nurses spent on clerical work and on
such duties as bathing and taking trays to patients,
it was stated that in some hospitals practical
nurses gave medication and performed other rela­
tively responsible duties.
Nonprofessional help are literally treated with kid
gloves at the expense of the nurses. They refuse to do
their work, do it slovenly, are openly abusive and
when such situations are reported, the nurse is in­
variably held at fault.
The once “thrill” of being “capped” is gone. We
find a few months course and we can become a
“trained” nurse, cap and all and practically receive
the same salary as an R. N. Many of our public does
not know the difference. We once had something to
look forward to at the end of our 3- or 5-year course,
a cap and that wonderful distinction of being an
R. N., an honor we wanted the whole world to know;
we were a little different than others. Now we even
take orders from nonprofessionals; instead of doing
what we know is best; and like it.
I believe that where there is a shortage of registered
nurses there is a need for nurses’ aides. There are
many things which nurses’ aides can be trained to do
but I feel that the administration of medicines and
assisting with operations, etc., should be done only
by those trained professional nurses who are fit for the
responsibility involved.
This hospital allows these practical nurses to do
medications, intravenous, and all procedures in gen­
eral, however, you hear complaints from patients
continuously about poor treatment. This hospital
also calls practical nurses to do private duty when
there are registered nurses available.




I really don’t blame girls for not taking up nurses’
training when they can get positions in the profession
without a moments training of any sort, right out of
high school, are requested to wear white caps and
white uniforms and white hose—and receive the same
pay as R. N.’s or graduates. Also dental assistants
wear white caps, white uniforms . . . and receive a
higher wage than R. N.’s working in an M. D.’s office.
The nurses white uniform is worn by any one who
wishes to don it and it certainly burns up we R. N.’s.
Why should girls take nurses’ training. When these
aides work a few weeks as aide then do private duty
nursing and charge as much or more for their work.
They have no registration fees, no 3 years’ hard work
without pay, etc.

The poor quality of institutional meals was
referred to in comments like the following;
Nurses study nutrition and dietetics as a part of
their course. But why I’ll never know, if the food
served them is an example of a well-balanced meal.
After a hard day of work one is able to finish off a
good wholesome meal with no effort. The only trou­
ble was the fact that we never had one to finish off.
Meals at the hospital, I have found as have many
others, are just put together. No one bothers to make
the menu appetizing. One hospital I worked in sev­
eral months ago served mashed potatoes and peas for
the main meal (on Sunday), one slice of toast and as­
paragus for supper. How can a nurse running for 8
full hours possibly exist on food of this sort? I realize
that this was in one particular hospital but, if this is
going on in one hospital, there must be other places.
Complain to the superintendent at the hospital and
they say we will look into the matter and that is as
far as that goes.

Regional Differences in Opinions
Institutional and private duty nurses on the
Pacific Coast, where working conditions were
generally the best, expressed most satisfaction,
Attitudes of public health nurses, varied less con­
sistently among regions than those of private duty
or institutional nurses.
Private duty nurses in the Middle Atlantic
States were generally least content. An impor­
tant exception was the hourly rate of pay, which
was considered least satisfactory in New England,
the only region where most private duty nurses
received less than $1 an hour. Private duty
nurses in the South and in the regions west of the
Mississippi were less discontented than those in
other States.
A tabulation of opinions of institutional nurses
in 10 large cities indicates that, although the rela­

PART I.

ACTIVE NURSES

tive position of the cities varies somewhat from
item to item, nurses in Los Angeles and Baltimore
were on the whole more satisfied than those in
other cities studied. However, hours in the latter
city were considered more unsatisfactory than in
a number of areas.

Factors in Opinions
What accounts for differences in the attitudes
of nurses within the same field? In an effort to
find out some of the reasons for these differences,
opinions of nurses were classified by certain
personal characteristics and by characteristics of
their places of employment.
An attempt was made to determine whether
within each of four fields of nursing42 dissatisfac­
tion with hours of work was greater among those
working the longest hours. This analysis in­
dicated that such a relationship did exist in the
case of nurse educators and institutional nurses
although it was not entirely consistent. A
similar tendency was also evident to a limited
extent among industrial nurses although almost
all of them worked relatively short hours and
considered their hours satisfactory. The greatest
dissatisfaction with hours of work was found in
the institutional field, where the longest hours
were in effect.
Dissatisfaction tended to be less pronounced
among older nurses, who more frequently ex­
pressed “no opinion” on various aspects of their
work than did the younger nurses.43 There was
no clear-cut variation with amount of education
in the opinions of public health or institutional
nurses except for a smaller degree of dissatisfac­
Private duty and public health nurses were excluded from this analysis.
* The analysis of the variation of opinions with age and experience was
limited to the three fields employing the largest number of nurses—institu­
tional, private duty, and public health. Like all other analysis of the varia­
tion of attitudes with special characteristics it was limited to representative
aspects of nurses’ working conditions instead of all aspects about which
inquiries were made. In the case of public health nurses, the study of varia­
tions in opinions according to age, experience, and other factors was confined
to the four conditions that they considered most unsatisfactory. The extent
of dissatisfaction regarding other aspects of their work was not great enough
to make significant variations in viewpoints with personal characteristics
likely.
Summary of the difference in satisfaction of institutional and private duty
nurses with age is complicated by the fact that while their dissatisfaction
decreased with age, positive statements of satisfaction increased very little
and on most aspects actually declined with age. On most aspects of their
work, however, complaints decreased more than satisfaction. The decline
in dissatisfaction with age was true not only for all institutional nurses but
for general staff nurses considered separately.




45

tion among nurses with only 24 to 35 months
of basic nursing education. These were generally
older nurses, and it is probable that age rather
than education was the determining factor in
their attitudes.
The comparatively small group of private duty
nurses with graduate education and those with a
4- or 5-year basic course were more dissatisfied
than those with only a basic education of 3 years
or less. Dissatisfaction was greater among those
with graduate collegiate than those with advanced
clinical courses.
Among institutional nurses, there was a tend­
ency toward greater dissatisfaction among the
lower paid, less responsible positions regarding
certain tangible aspects of their work; but (except
for administrators who were less dissatisfied)
their views did not vary markedly on a number of
items (including opportunities for social contacts,
provisions for retirement, the number of duties,
the quality and quantity of nonprofessional help,
and the quality of supervision). Those in the
most responsible jobs expressed “no opinion”
more frequently than other institutional nurses.
Items on which those in supervisory positions were
less dissatisfied included several in which they
fared better than staff nurses, but one at least
(length of workweek) in which they did not fare
as well.44* Complaints with respect to most
items were more numerous among the small group
of assistant head nurses than among general staff
nurses.
Private duty nurses who were veterans of the
armed services were more dissatisfied than others
in their field; veteran status did not appear to
affect the views of institutional nurses. Federal
Government nurses were the least dissatisfied of
all institutional nurses. Among these Federal
employees, those in armed services hospitals were
apparently least dissatisfied although a high pro­
portion expressed no opinion on many items;
veterans* hospital employees were the most dis­
*
satisfied. Municipal and county government
employees ranked next to those in Federal
hospitals in dissatisfaction, followed by State
institutions. Nongovernmental hospital nurses
44 Other aspects of their work with respect to which they were less dis­
satisfied were their hourly rate of pay and the requirement of night work, as
well as grievance procedures, chances for and methods of determining pro­
motions and pay increases, opportunities to exercise professional judgment,
and the job as a whole.

46

ECONOMIC STATUS OP REGISTERED PROFESSIONAL NURSES

were generally most discontented, although this
attitude did not apply to all items.
The greatest contrast in opinions of institu­
tional nurses was that over retirement provisions—
these were considered satisfactory by three out of
four Veterans Administration employees but un­
satisfactory by almost half of the county and
municipal nurses and by two out of three em­
ployees of nongovernmental hospitals. Nurses
in armed service hospitals were most satisfied with
promotional opportunities and those in all types
of Federal hospitals were most content with their
pay, hours of work, and nonprofessional help.
Opinions did not vary appreciably among nurses
in hospitals of different proprietorships regarding
the quality of supervision, service to the commu­




nity, the job as a whole, and their duties.45
Size of hospital did not play a major role in the
attitudes of institutional nurses. On a consider­
able number of working conditions46 there was
either little or no consistent variation in attitudes
with size of hospital. On other points47 dissatis­
faction was somewhat greater in large than in
small hospitals. Dissatisfaction with pensions for
retirement and employment security was smallest
in very large hospitals.
48 Aspects of their duties on which attitudes did not differ included timing,
hours spent on professional duties, and (except for more complaints in veter­
ans' hospitals) opportunities to exercise professional judgment.
48 Including the requirement of night work, evenness of the work load,
opportunities for promotion and for professional and social contacts, and the
job as a whole.
47 Arduousness of duties, allocation of time between professional and non­
professional work, and quality and quantity of nonprofessional help.

Part II. Inactive Nurses

.

Chapter 1 Em ploym ent Status and Reasons for
Leaving Nursing
The major reason nurses leave their profession
is to marry rather than to enter other fields of
employment. Of the inactive nurses who had
retained their professional registration in the early
months of 1947, four out of five were housewives
not working outside their homes; less than a
tenth were employed outside nursing or were at­
tempting to find such work.1 About 7 percent
were actually employed outside nursing and
another 2 percent were either seeking work outside
nursing or taking nonnursing education. The
following tabulation shows the employment status
of those respondents to the questionnaire who had
left nursing but had maintained their registration
in the profession.
The study does not indicate that the attraction
of other jobs has become an increasingly important
reason for leaving the profession in recent years,
although there has apparently been an increase in
the number of nurses leaving for this as well as for
other reasons.
The limitation of the survey to those who had
maintained their registration as nurses necessi­
tates caution in interpreting the information on
the proportion working outside nursing. It may
be that those who left to seek other work had
severed all ties with their former profession more
frequently than those who had married and no
longer worked outside their homes. Neverthe­
less, the proportion of inactive nurses who were
1 Of the remaining 10 percent, about half stated that they were retired or
unable to work and half stated their intention of returning to nursing. (The
latter were taking advanced nursing education, were on extended unpaid
vacations or terminal leave, or were seeking work in nursing but were un­
employed.)




housewives was so overwhelming that, even if
allowance were made for this possible bias, it
seems safe to conclude that the major reason for
graduate nurses leaving their profession is marriage
and not the competition of other fields of em­
ployment.
All inactive nurses_____________________________ 100. 0
Employed outside nursing______________________
Anesthetists_______________________________
Teachers (other than in nursing)____________
Office workers_____________________________
Sales workers_____________________________
Medical laboratory technicians or assistants _ .
Physical therapists________________________
Occupational therapists____________________
Social workers_____________________________
Operating own business.................
Other nonnursing employment______________
Not employed_________________________________
Housewives (not working outside home)_____
On extended unpaid vacation or terminal leave
from armed forces—intending to return to
nursing_______________________•__________
On extended unpaid vacation or terminal leave
from armed forces—not intending to return to
nursing_________________________________
On terminal leave—planning further nursing
education before further civilian nursing___
Taking advanced nursing education_________
Attending school (not nursing)______________
Unable to work or retired__________________
Unemployed (seeking work as a nurse)______
Unemployed (seeking work outsidenursing) . _
Other_______________

6. 9
.3
.2
.8
.4
.4
.3
Q)
.4
1. 6
2. 5
93. 1
79. 1
.7
.1
0)
2. 5
1. 4
5. 3
1.1
.4
2. 5

Number of replies to question___________________9, 082
1Less than 0.05 of 1 percent.

47

48

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

Social and Economic Factors
The facts just outlined do not mean that the
economic status of nursing as well as general
economic conditions have no effect on continua­
tion of graduate nurses in the profession.2 Those
who had entered other fields of employment most
frequently gave higher salaries and more regular
hours outside nursing as their major reason for
changing their work. Relatively long hours, hard
work, limited opportunities for promotion, and
difficulties in advance planning of leisure time in
nursing were also sometimes pointed to as the
leading factors in their, transfer to other jobs
(table 31). Data on the earnings and hours of
this group which had sought other jobs indicated
that their hours were, in fact, shorter and their
earnings higher than the average in effect in
nursing. (See pt. III.)
31.—Reasons for leaving nursing reported by inactive
nurses1 (excluding retired nurses and those taking ad­
vanced nursing training), 1947

T able

Reason for leaving
Married, and nursing hours
interfered with home life__
No longer needed to work........
Left temporarily for personal
reasons—intending to re­
turn........................................
Transferred to other work—
Paying higher salary........... .
Because of irregular hours
in nursing...........................
Less arduous work.................
With shorter hours...........
Because nursing did not
permit advance planning
of leisure time....................
Because of limited oppor­
tunities for promotion in
nursing................................
Because of unsatisfactory
supervision in nursing___
Because of living conditions
in hospital...........................
Left because of inability to
find nursing work..............

All replies

Percent reporting—

Num­ Per­ A » Major Minor No
ber cent reason reason reason reason
76.7
15.1

51.9
5.2

5.2
7.6

23.3
84.9

100.0 11.1
100.0 4.8
100.0 4.6
100.0 3.9
100.0 3.5

6.5
2.8
2.4
1.9
1.9

2.9
1.5
1.9
1.5
1.2

88.9
95.2
95.4
96.1
96.5

8,229 100.0
8,099 100.0
8,100
8,086
8,084
8,088
8,084

8,085 100.0

3.5

1.4

1.9

96.5

100.0
100.0
100.0
100.0

3.0
1.9
.7
1.0

1.5
.9
.2
.4

1.2
.9
.4
.4

97.0
98.1
99.3
99.0

8,082
8,083
8,080
8,081

1Includes only those who have maintained current registration.
2Includes those not stating whether reason was major or minor.

While many, and presumably most, women
with families to care for would not return regard­
less of economic conditions in their profession,
some did indicate that better pay and working
conditions would enable them to hire someone
to take care of their homes and thus to return to
nursing. However, under present conditions, they
2 The most important effect of economic factors—that on enrollment of
student nursesr-is discussed in pt. IV.




stated, the expense of working and paying to have
their families and homes cared for would be about
equal to their earnings. The following quotations
are typical:
I have to pay a baby sitter 75 cents to a $1 an hour
and cannot be sure my baby is not being neglected.
On the other hand, I put in 3 years of good hard work
without pay, plus fees, books, clothes, and personal
expenses. . . . For 8 hours of my time and effort
in nursing I am paid $7.50 plus 1 meal of tasteless
institutional food. Ninety cents of that $7.50 is
withheld for tax. It costs me 60 cents to have a
uniform laundered and 20 cents for carfare.
Out of the $7.50 I pay out a total of:
Baby sitter_________ ___ $6. 00 to $8. 00
Laundry___________ ...............60
Carfare____________ ___ .20
Withholding tax____ ...............90
7. 70 to 9.90
In other words, it costs me from 20 cents to $2.20,
plus 9 hours of my time (8 on duty and 1 hour en
route), to help relieve the nursing shortage.
For the average married nurse with children, the
hourly rate of 87% cents is insufficient. Day nurseries
require a minimum of $14 per child for 5 days a week.
The price of nurses’ uniforms has increased with the
cost of laundry and traveling expenses, it really does
not pay me to go to work as much as I would sincerely
like to help out in the nursing shortage.
I feel that many married nurses would be able to do
extra work or relieve staff nurses for vacations, illness,
etc., if they were paid sufficiently. I know most of
us must pay a girl $2 to $3 per day to care for our
children (and we are not always certain of capable
persons) and then our living wages increase as one
spends more for food when you are rushed for time
than when you plan your home work. The extra cost
or work of uniforms and taxes use up the $4 to $5 that
is usually paid in this locality (I did receive $6 last
October) but I feel it should be the price of a private
duty wage as one does not make any profit on such a
wage and our husbands flatly say “No.”
I am married and have 2 children whom I love and
if I wanted to work now—would have to find, which
is impossible, a larger home in order to have some one
to care for my children, then if I did get some one
they ask for more than I’d receive after paying car­
fare, etc., which would make me working for nothing—
furthermore I feel my children come first.

Although 10- and 12-hour days were compara­
tively rare, they still existed at the time of the
study. Where they did, they were a particular
deterrent to married nurses’ employment.
It is impossible for married nurses to maintain a
home and do 12-hour duty. If we had 8-hour duty,

PART II.

INACTIVE NURSES

better pay (and pay that would make it worth our
while), we would all be back on the job.

Some married women indicated that they would
work if they could arrange part-time schedules or
could remain on the same shift continuously:
Many of us would like very much to work but parttime working is impossible as the one thing we want to
know and plan is what hours we’ll be working. It
seems the hospitals cannot arrange working hours so
this is impossible.

Arrangements for part-time work and stable
schedules were in effect in some hospitals although
they apparently created some dissatisfaction
among single nurses who felt that their hours were
adversely affected. Many married nurses went
into the private duty field because it gave them the
opportunity to work part time and to adjust their
working time more easily to their personal lives.

The Postwar Problem
Apparently the number of graduate nurses who
had left their profession was particularly high at
the time of the survey—so high that, despite an




49

increase in the number of students graduated dur­
ing the war and increased demands for nursing
care, the number of employed nurses had increased
only slightly over prewar years. With the high war
and postwar marriage rate, many established or re­
established homes after the war and many had small
children requiring their care. Moreover, the gen­
eral economic situation increased the expense of
hiring domestic help and made it unnecessary for
many married nurses to work to supplement their
husbands’ incomes. In the 1930’s some postponed
marriage because of economic conditions. Al­
though at that time many hospitals hired single
nurses in preference, married nurses continued to
work or seek work because their husbands either
were unemployed or did not earn enough to sup­
port the family on their income. (The restrictions
on employment of married nurses have been greatly
relaxed during war and postwar years.) Then dur­
ing the war many married women remained in
nursing for patriotic reasons and because their
home duties were reduced while their husbands
were in service.

.

Chapter 2 Characteristics
How did those nurses who were not active in
nursing compare in personal characteristics with
those engaged in their profession? As indicated
in the previous chapter, a very large majority of
the inactive nurses were married and working
only as housewives; indeed the inactive group as
a whole differed more in marital status and ex­
perience than in other characteristics from those
still employed as nurses.
Altogether, over four-fifths of all inactive nurses
were married and two-fifths had dependents at the
time of the Bureau’s study. Among those em­
ployed outside nursing, however, the proportion
of married women was only slightly higher than
. among those still active in nursing. (See table 5,
p. 9.)
Those who had left nursing reported distinctly
shorter nursing experience than those still active—
5, compared with 9, years. Within this group, the
average experience of those who were retired was
14 years; professional experience of those employed
outside nursing was the same on the average as
for all active nurses. (See table 2, p. 7.)
50




The average age of inactive nurses was only a
year below that of the active group—their ages
were 33 and 34 years, respectively. Those em­
ployed outside nursing were a few years older than
either the active nurses or those who were house- *
wives. (See table 1, p. 7.)
A somewhat smaller proportion of inactive than
of active nurses reported some advanced nursing
education—20 percent and 30 percent, respec­
tively. However, 1 in 3 of those employed out­
side nursing and half of those planning to return
to nursing had such graduate education. (See
table 3, p. 8.)
A slightly smaller proportion of inactive than of
active nurses were veterans, but veteran status
varied widely among different groups of inactive
nurses. Three-fifths of those planning to return
to nursing were veterans, as were two-thirds of
those seeking work outside their profession. In
contrast, only 1 in 9 housewives had been a mem­
ber of the armed services. The proportion em­
ployed outside nursing and the proportion of active
nurses who were veterans was about equal. (See
table 4, p. 9.)

Part III. Comparison With Earnings and Working Condi
tions in Other Fields
In order to provide a background against which
the information on earnings and working condi­
tions of registered professional nurses could be
evaluated, the Bureau of Labor Statistics attempt­
ed to compile available information on earnings in
other fields that compete either directly or indi­
rectly with nursing. Two types of information
have been assembled here: (1) Data on earnings
and working conditions in occupations into which
potential nursing students can go without
training comparable to that required of registered
professional nurses, and (2) earnings and working
conditions in occupations and professions employ­
ing large numbers of women with a considerable
amount of specialized education. Unfortunately,
however, the amount of reasonably current infor­
mation that is available on professional groups in
which substantial numbers of women are employed
has proved to be very meager.

Earnings
The available information on nonprofessional
jobs indicates that while there are many workers
in the country earning less than the average nurse,
there are occupations requiring much less training
that provide hourly pay equal to or above that of
most nurses. Thus in October 1946 women assem­
blers requiring little special training averaged $1
an hour (the average earnings of nurses) in the
machinery industries, while sewing-machine oper­
ators making women’s clothing averaged well
above this amount. Most retail clerks apparently
earned less than $1 and women in jobs requiring
relatively little skill in some of the chemical indus­
tries received about 80 cents, on the average, in
July 1946.
Average hourly earnings in nursing were some­
what above those in office jobs into which highschool graduates can go with relatively little




specialized training, but were lower than those in
office jobs requiring considerable advanced training
or experience on the job (such as stenographers
who take technical dictation and bookkeepers).
In the fall of 1946, when nurses averaged $1 an
hour, earnings of women in the office jobs for
which data are available varied from roughly 80
cents an hour for clerk-typists to around $1.10$1.15 for bookkeepers.
Although no group is strictly comparable with
nurses, salaries of teachers are of particular interest
because of the high proportion of women in both
professions and the fact that the average time
spent on education by members of the two fields
is about the same.1 (However, the cash expendi­
ture required for teachers’ training is generally
much above that of nurses.) Salaries of teachers
in city school systems were distinctly higher than
those of nurses, but inclusion of rural school sal­
aries would probably about equalize the average
salary of nurses and of teachers. Assuming full
employment, nurses’ annual salaries were about
$2,100 a year while the average for city school
teachers was about $2,500 annually in the 1946-47
school year.2 If the very large group of teachers
in rural schools were included, a comparable figure
would, it is estimated, be about $2,100 for the
same period.3
1The average amount of education of city school teachers is reported to be
3 or 4 years beyond high school. National Education Association of the
United States, Research Division, Salary Trends, No. 2 (October 1946), p. 2.
* Includes elementary, junior, and senior high school teachers in communi­
ties of 2,500 or more. County and other rural school systems are omitted
(see National Education Association, Salaries in City School Systems,
1946-47).
* This is an estimated median salary. The Research Division of the
National Education Association, in Schools and Economic Trends Release
No. 3 (November 1947), estimates that a weighted mean for all school teachers
including supervisors and principals in public elementary and secondary
schools would be $2,250 for the year 1946-47. Available evidence indicates
that the mean salary for teachers is considerably above the median. The
average for city school systems ($2,500) is a median, and such a measure is
believed to be more closely comparable with the data presented for nurses
than a mean would be.

51

52

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

Earnings of California medical laboratory tech­
nicians, who had more education and experience
than the average nurse, were apparently above
those of California nurses, but in New York State,
staff nurses, salaries seemed to be on a level with
those of laboratory technicians. Medical labora­
tory technicians in California received average
weekly salaries of about $50 in January 1946.
These technicians typically had a bachelor’s
degree and averaged about 8 years of experience
in their work.4 (Nurses in California earned
around $50 a week about 9 months later.) A
study of workers in New York State made in
July and August 1946 showed average annual
earnings of hospital staff nurses to be on a level
with those of X-ray technicians, occupational and
physical therapists, and laboratory technicians but
below those of social workers and of workers in
relatively responsible clerical positions.5
Those participants in the present study who had
left nursing for other fields of employment earned
an average of $188 a month, about $12 above
nurses’ cash earnings.
The regional pattern of nurses’ earnings differs
somewhat from that in other fields. The South­
eastern States paid the lowest salaries to their
teachers while New England nurses reported the
lowest pay. Highest salaries were reported in the
Pacific States for both nurses and teachers; the
average for teachers in these States was almost
twice as high as that in the Southeast. Estimated
average salaries of teachers in all regions can be
summarized as follows:
Estimated average
Region

salaries of school
teachers as a per­
centage of the
United States
average, 1946-471

New England______________________
Middle Atlantic____________________
Border States___________________
Southeast_______________________
Southwest______________________
Middle West____________________
Great Lakes_______________________
Mountain_______________________
Pacific____________________________

110
127
87
70
86
80
106
94
130

1Includes supervisors, principals, and teachers in public elementary and
secondary schools. (National Education Association, Advance Estimate of
Public Elementary and Secondary Schools for the School Year 1947-48.)
Averages are means rather than medians.*
4 California Association of Medical Technicians, The Filter, July 1946,
pp. 4-5.
* State of New York, Department of Civil Service, Salary Standardization
Board, Survey Report (January 1947).




The pattern of regional differences in earnings
of factory workers varied from industry to industry
although in general the lowest earnings were found
in the Southeast and the highest on the Pacific
Coast. Generally, New England plant workers’
earnings exceeded those in the Middle West and
Southwest.

Hours and Other Working Conditions
Hours and other working conditions in and out­
side the nursing field at the time of the Bureau’s
study can be roughly compared as follows:
1. Hours of work were shorter and more regular
outside nursing than in most branches of the pro­
fession. Women in office work and in most manu­
facturing plants typically worked about 40 hours
a week. There were exceptions, particularly in
retail trade, where 48-hour schedules were fairly
widespread. Information on hours of teachers
was difficult to obtain, particularly because of the
time they spend on school work outside regular
classroom hours. Inactive nurses who had gone
into other jobs averaged about 41 hours weekly in
October 1946, compared with a 44-hour average
for those who had remained in nursing. Time on
call and split shifts, still found to a substantial
extent in nursing, were unusual in other fields into
which large numbers of women go.
2. Proportionately fewer women in industry
worked at night than did nurses and they more
frequently received premium pay when they did
go on the night shift.
3. In contrast to nurses and teachers, workers in
industrial establishments generally received over­
time pay at time and a half their regular rate.
Teachers fared less well in overtime provisions
than nurses, who sometimes got some compensa­
tion for overtime.
4. Paid vacations and sick leave were more wide­
spread and liberal for nurses than for workers in
industry. Teachers had even longer vacations
and fared about as well as nurses in sick leave
arrangements. Vacations of industrial workers
were most commonly 1 week in length after 1
year’s service while 2-week vacations were most
frequent for office workers.6 Longer vacations
were unusual for industrial or office workers and
they were generally not covered by sick leave
8 Monthly Labor Review, September 1947, p. 331.

PART III.

COMPARISON WITH OTHER FIELDS

plans. The great majority of California medical
technicians received vacations (frequently from
10 to 20 days in length) and sick leave.
5. Nurses did not fare as well in provisions for
retirement as most other groups for which compar­
ative data were available. City school teachers




53

were generally covered by retirement pension
plans; also over two-thirds of the California
medical technicians were included in such plans.
Most workers in American industry are covered
by the retirement and unemployment compensa­
tion provisions of the Social Security Act.

Part IV. Why the Supply of Nursing Care Has Lagged
Why has the supply of nursing care failed to
keep pace with the demand? The study summar­
ized here, supplemented by other available infor­
mation, indicates that transfer of graduate nurses
to other jobs is only a minor factor in the shortage;
rather, the major reasons are the drain of women
leaving the profession because of marriage, and the
attraction of many potential students to other
fields. The problem is acute at the present time
because postwar social and economic conditions
in and outside nursing have apparently increased
the number of married women who are leaving
their profession and have decreased rather than
increased enrollment of students at a time when
there has been a sharp rise in the demand for nurs­
ing service.1 This decline in student enrollment
not only affects the potential supply of graduate
nurses but reduces the amount of nursing care that
is immediately available, since students provide
much of this care during their period of training.
Numerous comments indicate that conditions
in nursing (particularly salaries and hours of work)
deter some nurses from continuing to work after
marriage. However, in the high proportion leav­
ing because of marriage, nursing does not differ
from most other occupations in which women are
numerically important,2 and it is impossible to
predict just how much effect better working con­
ditions would have on employment of married
nurses.
Conditions in nursing compared with other
fields of employment apparently affect the supply*
1 The total number of students at the time of this study was still above
prewar levels but below the wartime peak, as well as below estimated needs.
The drop in enrollment began in 1945, when student admissions were lower
than before the war; therefore, the number of graduates will begin to decline
in 1948. The postwar shortage is further aggravated by the decline in the
number of volunteer nurses' aides below wartime levels.
* It should be pointed out that the proportion of married women was lower
in nursing than in many other fields of employment at the time of the 1940
census. Since that time opportunities for their employment in many
hospitals have improved so that the proportion has appreciably increased.

54




of nursing service primarily at the point of en­
trance into nursing schools rather than among
those who have completed their nursing educa­
tion. At present, these conditions seemingly
are leading many potential students into office or
factory work. These girls believe that such work
offers them salaries and working conditions that
compare favorably with those provided by nursing
when allowance is made for the fact that these
other fields do not call for the 3 years of training
required of professional nurses. Reference to
available data indicates that in actual fact some
but not all occupations requiring less training
than nursing provide earnings and working con­
ditions that compare favorably with those of
nurses. The appeal of immediate or almost
immediate earnings is particularly great to those
girls who plan to marry within a few years. This
situation was referred to in many comments from
nurses who participated in the present study.
Young girls soon learn that the work is long and
arduous, hours are most unattractive, and the net takehome pay pitifully inadequate. They soon learn that,
in comparison with outside situations, there is smaller
chance of promotion, that is paid promotion, though
for the most part the outside situations required less
time and money spent on education and prepara­
tion. . . . Every one admits that nursing is a highly
responsible position where one cannot grab one’s hat
at the sound of a bell, walk off duty, or claim any
remuneration for extra hours spent on duty in the
frequent emergencies that arise. Those emergencies
are accepted and they are frequent and there are no
compensating factors to balance them. Prospective
nurses becoming acquainted with the conditions
cannot be blamed for saying “Not me.”
I believe there are several reasons why so few young
girls are interested in nursing as a career. The time
and money spent for training of the nurse and the
monetary remuneration does not compare favorably
with any other group of women workers except the
teacher. The teaching profession has also found
themselves facing a national teacher shortage. Most

PART IV.

W HY SUPPLY OF NURSING HAS LAGGED

business organizations have some type of retirement
and sick benefits. I do not believe that nurses work
for purely material gain but I believe every individual
who works for his livelihood should have a fair wage
for his efforts. I think this feeling of insecurity makes
many girls hesitate about choosing nursing as a career.
The war has provided work for girls with little or no
training and education hence few girls have enter<xi
the professions which required long terms of training.
Why should young American women 18 years or
over enter a school of nursing for 3 years and get $1 an
hour after she has graduated when an 18-year-old
person with a public school education enters a school
for practical nurses . . . and graduate after 9 months
course and still get $1 per hour?
Perhaps the reason few girls are entering train­
ing . . . is that other fields offer a better inducement.
Unless one expects not to get married . . . 3 years is
a long time to train after the time required in other
schooling preparations.

Entrance of students apparently is influenced
not only by potential earnings and working
conditions but by conditions in nursing schools.
This aspect of the problem was not studied by




55

the Bureau of Labor Statistics but comments
from some participants in the survey questioned
various aspects of student training, including
lack of pay during the training period, heavy
duties, restriction on personal freedom, and lack
of recreational facilities, as well as poor selection
of students.3
The importance of marriage as a factor in the
nursing shortage coupled with the relatively short
period (4 years) that nurses who become house­
wives remain in their profession and the substantial
amount of time those who work in hospitals spend
on nonprofessional duties may well indicate a
need for a basic re-evaluation of the system of
nursing education. Shorter periods of preparation
for some nurses and perhaps even longer periods
of education for fully professional nurses have
been suggested.*
* For further discussion of opinions regarding student training, see pt. I,

ch. 8.

APPENDIX A

Supplementary Tables
A -l.—Average monthly earnings of institutional and public health nurses and nurse edu­
cators in selected positions, October 1946.
A-2.—Maintenance provided institutional nurses and nurse educators, October 1946.
A-3.—Average monthly earnings of institutional and public health nurses and nurse edu­
cators, by age, October 1946.
A-4.—Average monthly earnings of institutional and public health nurses, by employer,
October 1946.
A-5.—Average monthly earnings of institutional nurses, by hospital size, October 1946.
A-6.—Average monthly earnings of nurses, by community size, October 1946.
A-7.—Hourly rates of pay of private duty nurses, by community size, October 1946.
A-8.—Hourly rates of pay of institutional nurses for night-shift work, 1947.
A-9.—Usual scheduled hours on duty of institutional nurses, by shift, October 1946.
A-10.—Usual scheduled hours on duty of institutional nurses on the day shift, by employer,
October 1946.
A -ll.—Usual scheduled hours on duty of public health nurses, by employer, October 1946.
A-12.—Actual monthly horns on duty of institutional nurses, by hospital size, October 1946.
A-13.—Annual paid vacations after 1 year’s service, institutional and public health nurses,
1947.
A -14.—Paid sick leave after 1 year’s service, institutional and public health nurses, 1947.
A-15.—Insurance and retirement plans provided institutional and public health nurses, 1947.
A-16.—Hospitalization and medical care provided institutional and public health nurses, 1947.
A-17.—Insurance and retirement plans provided instititutional nurses, by size of hospital,
1947.
A-18.—Duties of institutional head and general staff nurses—Percent of time spent on major
groups of duties.
A-19.—Duties of institutional nurses, by size of hospital—Percent of time spent on major
groups of duties.
A-20.—Number of nurses replying to questionnaire, by region and employment status.
56




APPENDIX A,

T able

57

SUPPLEMENTARY TABLES

A -l. — Average 1 monthly earnings 1 of institutional and public health nurses and
2
nurse educators in selected positions, October 1940
F ield, position, and livin g arrangem ent

INSTITUTIONAL NURSES
All positions: 3
......
L iving in hospital quarters
L iving outside hospital quarters _ ...
D irectors or assistant directors of nurses:
L iving in hospital quarters
_______________________________
L iving outside hospital quarters________________________________
Supervisors or assistant supervisors of nurses:
L iving in hospital quarters_____________________________________
L iving outside hospital quarters________________________________
H ead nurses:
L ivin g in hospital quarters_____________________________________
L ivin g outside hospital quarters________________________________
A ssistant head nurses:
L iving in hospital quarters_____________________________________
L iving outside hospital quarters
General staff nurses:
L ivin g in hospital quarters_____________________________________
L iving outside hospital quarters________________________________
PUBLIC HEALTH NURSES
A ll p o sitio n s3___ __ ____ _______________________________________
Staff nurses
__ _____________________________________________
School nurses____________________________________________________
NURSE EDUCATORS
A ll positions: 3
L iving in hospital quarters
.
_____
L iving outside hospital quarters
F ull-tim e instructors:
L ivin g in hospital quarter^
L iving oufcdde hospital quarters.
. __

N um ber of replies

A verage m on th ly
earnings

899
3,443
83
80
162
388
181
735
43
237
300
1,509

$160
172
229
239
164
184
153
182
144
169
151
161

1,243
555
297

184
177
182

122
257
68
152

194
207
181
201

1 Median.
2 Includes cash paid in lieu of maintenance but excludes the cash equivalent of maintenance provided by employers.
*Includes data for positions not shown separately.




58

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

T a b l e A— .— Maintenance
2

1 provided institutional nurses and nurse educators, October 1946
Percent of institutional nurses

Kind of maintenance provided

United New Middle Border South­ Great Middle South­ Moun­ Pacific United Middle Great
States England Atlantic States east Lakes West west tain
States2 Atlantic Lakes

Nurses living in.............................................. 20.7
Room only.............................................. 1.3
Board and room..................................... 2.4
Room, board, and laundry of uni­
forms*................................................... 17.0
Nurses living out............................................ 79.3
1 meal a day............................................. 7.8
2 meals a day............................................ 4.4
3 meals a day........................................... 1.6
1 meal a day and laundry of uniforms3. 8.9
2meals a day and laundry of uniforms8. 8.9
3 meals a day and laundry of uniforms2. 8.8
Laundry of uniforms only *•_................. 9.1
No maintenance, or uniforms only....... 29.8
Total................... .................................. 100.0
Number of replies to question...................... 4,365

27.1
.7
2.2
24.2
72.9
10.4
3.8
.9
9.5
7.5
12.1
5.1
23.6
100.0
453

23.1
.8
2.1
20.2
76.9
7.7
6.6
2.1
9.8
13.2
10.8
7.7
19.0
100.0
1,016

1In addition to cash salaries.
2 Includes data for regions not shown separately.




Percent of nurse educators

33.3 33.2
1.4
.8
4.2
4.7
27.7 27.7
66.7 66.8
4.2
4.7
2.0
4.8
2.8
1.0
9.4
8.0
14.5
9.8
8.3 16.9
3.8
5.1
22.1 16.1
100.0 100.0
289
254~

15.0
1.6
1.0
12.4
85.0
9.5
4.5
1.3
10.4
7.0
6.8
10.7
34.8
100.0
1,159

21.9 22.9
11
1.7
2.9
2.8
18.0 18.3
78.1 77.1
11.0
7.4
4.2
6.3
2.9
4.6
8.5
9.1 '
9.5
8.6
7.8
9.7
8.1 12.0
24.4 21.1
100.0 100.0
283
175"

13.4
13
3.2
8.9
86.6
8.3
3! 2
.6
9! 6
7.0
7.6
14.0
36.3

11.4
23
3.0
6.1
88.6
4.1
L8
4
A3
3.2
3.0
14.1
57.7

32.3
16
2! 6
28.1
67.7
32
3! 4
1.6
7.9
6.8
9.2
6.1
29.5

30.7
69.3
5.7
4.5
13.6
9.1
1 3.4
33.0

30.8
o O
0. A
2.7
24.5
69.2
5.5
2! 7
.Q
J
7
8.2
3.6
6.4
5.5
36.4

100.0

100.0

100.0

100.0

100.0

157~

560~

380~

3 includes nurses who are also provided uniforms.

T a b l e A -3 .— Average 1 monthly

earnings * of institutional and public health nurses and
nurse educators, by age, October 1946
Institutional nurses2

Age
All ages *_.....................................................
Under 21 years...........................................
21-22 years...................................................
23-24 years...................................................
25-26 years...................................................
27-29 years...................................................
30-34 years...................................................
35-39 years...................................................
40-44 years...................................................
45-49 years...................................................
50-59 years...................................................
60 years and over.......................................

Public health nurses

Nurse educators2

Average
Average
Average
Number of monthly Number of monthly Number of monthly
replies
earnings replies earnings replies earnings
3,443
4
287
507
409
391
527
464
343
198
258
56

$172
(«)
157
160
164
169
176
181
182
187
188
183

1,243
l
15
59
51
91
180
236
198
150
204
55

$184

257

$207

U 156
159
164
174
180
183
189
200
198
199

5
18
27
34
42
45
36
26
18
2

(8) 194
190
197
212

210

220
270

(*)

252

2Median.
*Includes cash paid in lieu of maintenance but excludes the cash equivalent of maintenance provided by employers
3Limited to nurses living outside hospital quarters.
*Includes data for nurses who did not indicate their age.
*Insufficient number of replies to justify presentation of an average.

30.7

8S~

no

APPENDIX A.

T able

59

SUPPLEMENTARY TABLES

A-4.—Average 1 monthly earnings 2 of institutional and public health nurses, by employer, October 1946
Institutional general staff nurses

All institutional nurses
Living in hospital
quarters

Employer

Living outside hos­
pital quarters

Living in hospital
quarters

Living outside hos­
pital quarters

Public health nurses

Number Average Number Average Number Average Number Average Number Average
of replies monthly of replies monthly of replies monthly of replies monthly of replies monthly
earnings
earnings
earnings
earnings
earnings
All employers3..............................................
Federal Government:
Vpf.prans’ hospital
Arm#»d SArvinas

Other.....................................................
State government.........................................
County government.....................................
Municipal government................................
N ongovemmental........................................

899

$160

3,443

$172

300

$151

83
54
12
86
88
81
409

219
214
(4) 151
164
154
151

255
20
47
222
238
330
1,968

215
220
204
183
184
169
165

52
22
8
15
34
26
110

204
203
(4) 137
•
153
149
136

160
7
21
74
99
141
856

i Median.
* Includes cash paid in lieu of maintenance but excludes the cash equivalent
of maintenance provided by employers.

T able

1,243

$184

206
198
163
178
162
156

35
185
183
349
344

218
190
187
185
180

(4)

3 Includes data for nurses who did not indicate employer.
4Insufficient number of replies to justify presentation of data,

A-5.—Average 1 monthly earnings 2 of institutional nurses, by hospital size, October 1946

Hospital size and living arrangements
AU hospital sizes:3
Living in hospital quarters....................
Living outside hospital quarters-------Less than 50 beds:
Living in hospital quarters....................
Living outside hospital quarters...........
50-99 beds:
Living in hospital quarters...................
Living outside hospital quarters...........
100-149 beds:
Living in hospital quarters....................
Living outside hospital quarters...........
150-199 beds:
Living in hospital quarters...................
Living outside hospital quarters..........
200-299 beds:
Living in hospital quarters....................
Living outside hospital quarters...........

Average
Number of monthly earn­
replies
ings
899
3,443

$160
172

121
309

149
154

135
447

150
157

104
393

154
162

72
382

151
162

106
487

Hospital size and living arrangements
300-399 beds:
Living in hospital quarters.............................
Living outside hospital quarters_________
400-499 beds:
Living in hospital quarters.............................
Living outside hospital quarters____ _____
500-999 beds:
Living in hospital quarters.............................
Living outside hospital quarters..................
1,000-1,999 beds:
Living in hospital quarters.............................
Living outside hospital quarters...................
2,000 beds or more:
Living in hospital quarters.............................
Living outside hospital quarters......... ..........

Average
Number of monthly earn­
replies
ings
72
352

$158
172

49
209

180
184

80
391

174
187

73
194

194
201

68
182

199
200

164
168

1 Median.
3 Includes cash paid in lieu of maintenance but excludes the cash equivalent
of maintenance provided by employers.




$161

1,509

3 Includes data for nurses who did not indicate the size of the hospital in
which they were employed,

60

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES
T able

A-6.— Average 1 monthly earnings 2 of nurses,3 by community size, October 1946
Institutional4

Size of community

Industrial

Office

Number Average Number Average Number Average Number Average Number Average
of replies monthly of replies monthly of replies monthly of replies monthly of replies monthly
earnings
earnings
earnings
earnings
earnings

All community sizes *....................................................
Under 25,000........... ........................................................
25,000 and under 100,000................................................
100,000 and under 250,000..............................................
250,000 and under 500,000..............................................
500,000 and over..............................................................

3.443
760
600
493
401
1,082

$172
163
164
162
177
184

2,155
456
463
319
266
551

1 Median.
2 Includes cash paid in lieu of maintenance but excludes the cash equivalent
of maintenance provided by employers.
3 Except nurse educators.

T able

Public health

Private duty

$153
130
147
154
169
171

$184
177
184
174
183
203

1,243
331
209
208
134
313

876
11
171
131
100
247

$196
187
199
187
200

914
224
185
130
106
242

$167
153
158
160
179
184

4 Limited to nurses living outside hospital quarters.
5 Includes data for nurses who did not indicate the size of community in
which they were employed.
6 Insufficient number of replies to justify presentation of information.

A-7.— Hourly rates of pay of private duty nurses, by community size,
October 1946
Communities of—
Hourly rate

75 cents............................................................
80 cents. _____________________________
85 cents............................................................
90 cents............................................................
95 cents............................................................
$1.00.................................................................
$1.05-$1.10.......................................................
$1.15-$1.20.......................................................
$1.25.......................................................... — .
Over $1.25...................................................
Other amounts.............................................
Total.....................................................
Number of replies to question.....................

T able

25.000
and
under
100.000

All sizes Under
25,000
4.3
.8
6.4
2.6
.8
60.1
4.7
2.9
10.1
1.0
6.3
100.0
2,483

100.000
and
under
250,000

3.4
1.3
6.7
4.0
1.1
65.8
5.1
1.6
4.0
.9
6.1
100.0
554

3.5
.5
7.5
5.0
.8
54.5
5.3
2.8
12.1
.5
7.5
100.0
398

10.9
1.4
8.9
2.3
.5
56.8
3.5
2.1
5.2
.7
7.7
100.0
575

250.000
500,000
and
under and over
500.000
1.3
1.6
.3
.3
75.5
5.5
5.8
6.1
1.3
2.3
100.0
310

1.1
.6
5.4
1.4
1.2
54.0
4.6
3.6
20.4
1.4
6.3
100.0
646

A-8.— Hourly rates of pay of institutional nurses for night-shift work,1 1947

Hourly rate of pay for night-shift work
Lower rate than for day shift___________________
Same rate as for day shift___ ___________________
Higher rate than for day shift__________________
Lass?than 5 pArofint higher
... _ _ _
At least 5 percent higher___________________
Total _____ __ ___________________
Nnmhfir replies to question
.
_

United New Middle Border
States England Atlantic States
12.7
55.0
32.3
23.0
9.3
100.0
2,566

13.1
52.6
34.3
26.7
7.6
100.0
251

15.1
57.0
27.9
20.3
7.6
100.0
595

13.2
52.3
34.5
23.6
10.9
100.0
174

South­
east

Great
Lakes

Middle
West

South­
west

Moun­
tain

19.0
59.9
21.1
12.6
8.5
100.0
142

9.0
59.2
31.8
23.9
7.9
100.0
655

15.9
55.0
29.1
26.5
2.6
100.0
151

17.6
70.4
12.0
9.2
2.8
100.0
108

11.8
54.9
33.3
19.6
13.7
100.0
102

1 Ezcludes nurses who normally do not work at night but includes both those who work on night shift only and those who rotate among shifts.




Pacific
10.1
41.5
48.4
30.1
18.3
100.0
388

APPENDIX A.

61

SUPPLEMENTARY TABLES

T able A-9.— U sual scheduled hours on duty 1 of institutional nurses, by shift, October 1946
Percent of nurses
Shift and scheduled hours on duty

United New Middle Border
States England Atlantic States

South­
east

Middle
West

Great
Lakes

South­
west

Moun­
tain

Pacific

DAT SHIFT

Less than 8 hours a day and 40 a week......................
8 hours a day and 40 a week........................................
8 hours a day and 44 a week........................................
8 hours a day and 48 a week.........................................
9 hours a day and 45 a week.........................................
9 hours a uay and 54 a week.........................................
10 hours a day and 50 a weak _. „ _ _ _ _ _ _
12 hours a day and 60 a WAAk
12 hours a day and 72 a waaV
Other periods.................................................................
Total....................................................................
Number of replies to question....................................

5.2
17.7
16.6
50.5
.9
2.6
.8
.4
.3
5.0
100.0
3,815

7.3
6.2
18.2
55.5
.8
3.4
.3
.5
.8
7.0
100.0
384

4.4
18.4
14.0
50.0
1.3
4.2
1.3
.7
.6
5.1
100.0
862

4.5
17.5
11.9
56.3
1.1
3.4
1.5
.4
3.4
100.0
268

3.7
14.7
15.2
58.1
.5
4.6
1.4
1.8
100.0
217

5.9
11.0
20.8
53.4
1.1
1.2
.7
.1
.1
5.7
100.0
1,047

3.7
9.6
8.7
67.6
.4
4.2
.8

2.4
9.5
27.8
48.4
.6
1.8
2.4

2.2
13.8
8.7
67.5
1.4
.7
1.4

6.7
49.9
16.3
22.2
.4
.8

5.0
100.0
240

6.5
100.0
169

4.3
100.0
138

3.5
100.0
490

5.7
22.8
17.4
48.6
.1
.7
.2
.1
.3
4.1
100.0
1,509

6.9
7.6
23.6
54.2

5.9
25.4
13.0
47.8

6.5
22.5
14.0
51.5

3.9
30.3
19.7
46.1

6.7
12.4
20.7
54.5

3.4
15.0
9.2
67.9

16.9
7.0
71.9

2.1
.7
4.9
100.0
144

.9

.5

1.1

6.8
54.3
15.0
21.4
.4

1.0

1.6
6.5
38.7
45.2
1.6

.3
5.9
100.0
307

.9
3.7
100.0
107

5.2
100.0
421

3.4
100.0
87

1.6
4.8
100.0
62

1.4
100.0
71

2.4
21.1
17.3
45.4
.4
1.7
.5
1.5
2.7
7.0
100.0
1,391 j

8.2
20.9
50.1
.7
1.5
1.5
2.2
4.5
10.4
100.0
134

1.5
21.0
11.6
47.6
.6
4.0
.6
2.4
4.6
6.1
100.0
328 j

3.2
20.0
14.7
48.4

2.7
6.8
30.1
42.6

4.0
24.0
14.0
48.0
2.0

.6

.2

EVENING SHIFT

Less than 8 hours a day and 40 a week___ _______
8 hours a day and 40 a week.........................................
8 hours a day and 44 a week.........................................
8 hours a day and 48 a week.........................................
9 hours ft day and 45 a WAA.k
9 hr»ors n. day and 54 a WAAk
10 hours a d ay and 60 a waaIt
1? hnnrs a day and 6ft a WAAk

__

12 hours a dav and 72 a week___________________
Other periods

Total.....................................................................
Number of replies to question.....................................
NIGHT SHIFT

Less than 8 hours a day and 40 a week___________
8 hours a day and 40 a week.........................................
8 hours a day and 44 a week.........................................
8 hours a day and 48 a week.........................................
0 hours ft. d ay and 45 a week
_
__ _

9hours aaday and 54 aaweek
10 hours day and 50 week___________________

12 hours a day and 60 a week___________________
12 hours a day and 72 a week.......................................
Other periods.................................................................
Total.....................................................................
Number of replies to question.....................................

.7

100.0
76
2.6
25.6
17.9
42.3
1.3
1.3
1.3
1.3
3.8
2.6
100.0
78

3.9
12.4
22.0
52.5

17.1
10.5
59.3
1.3

1.4
.8
1.4
5.6
100.0
355

2.6
2.6
6.6
100.0
76

2.7
1.4
13.7
100.0
73

2.0
6.0
100.0
50

.4
1.7
100.0
234
2.5
50.0
15.8
21.3
1.0
1.0
1.0
1.0
6.4
100 0
202

2 Less than 0.05 of 1 percent.

*Excludes meal periods.
T able

3.2
10.5
100.0
95

(*)

1.4
1.4

A-10.— Usual scheduled hours on duty 1 of institutional nurses on the day shift, by employer, October 1946
Scheduled hours on duty

Federal Government
All em­
ployers * Veterans’ Armed
Other
hospital services

State
govern­
ment

County
govern­
ment

Municipal Nongovern­
govern­ mental
ment

Percent of nurses
Less than 8 hours a day and 40 &w«ek _ _ _
8 hours a day and 40 a week..................................................
8 hours a day and 44 a week..................................................
8 hours a day and 48 a week..................................................
9 hours a day and 45 a WAAk
_ _
___
9 hours a day and 64 a week _
____________
10 hours a day and 50 a waek
___
12 hours a day and 60 a w^k
12 hours a day and 72 a waek
_ ________________
Other pariods
_______________________________
Total............................................................................
Number of replies to question------------------------ ----------

5.2
17.7
16.6
50.5
.9
2.6
.8
.4
.3
5.0
100.0
3,815

1.8
39.8
51.7
4.4

18.5
14.1
20.7
33.7

.3

4.3
1.1

2.0
100.0
342

7.6
100.0
92~

79.4
5.9
13.2
1.5
100.0
68~

3.1
5.1
18.8
61.2
1.6
2.7
1.2
6.3
100.0
256~

* Excludes meal periods.
2Includes data for nurses who did not indicate the proprietorship of the institution in which they were employed.




3.6
22.5
10.4
52.7
2.4
3.6
.4
.8
.4
3.2
100.0
249~

2.6
28.1
10.8
49.3
.3
2.6
.6
.3
5.4
100.0

JsT

6.0
12.1
13.4
57.5
.9
2.9
.6
.4
.3
5.9
100.0
2,083

62

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

T able

A -ll.— Usual scheduled hours on duty 1 of public health nurses, by employer,
October 1946

Munic­ Non­
All em­ Federal State County ipal
ployers 3 Govern­ govern­ govern­ govern­ govern­
ment
ment
ment
ment mental

Scheduled hours on duty

Percent of nurses
Less than 8 hours a day and 40 a week........................
8 hours a day and 40 a week..........................................
8 hours a day and 44 a week..........................................
8 hours a day and 48 a weak
ft hours a day and 45 a weak . . .
_ _ _

36.3
33.6

9 hours a day and 54 a weak
10 hours a day and 50 a waak
12 hours a day and 60 a waak
12 hours a day and 72 a week. .....................................

.1
.1
.1
6.2
100.0

Other periods...................................................................
Total......................................................................
Number of replies to question.......................................

21.0
2.1

17.2
69.1
10.3

.6

1,061

36.1
28.0
30.5
1.2
1.2

37.2
27.5
27.5
2.6

.3




.3
.3

3.4

3.0

5.2

5.2

100.0

100.0

100.0

9.8
100.0

164

153

307

305

A-12.—Actual monthly hours on duty 1 of institu­
tional nurses, by hospital size, October 1946
Hospital size

All hospital sizes 3_......... ............................................
Less than 50 beds.........................................................
50-99 beds....................................................................
100-149 beds..................................................................
150-199 beds..................................................................
200-299 bads
300-399 bads
400-499 bads
500-999 bads

30.2
34.1
21.3
3.3

100.0
29

1 Excludes meal periods.
2Includes data for those nurses who did not indicate employer.

T able

44.4
32.6
15.6
1.6
.3

__

1,000-1,999 beds.............................................................
2,000 beds or more........................................................

Number
of
replies
4,415
452
586
507
438
599
432
274
472
258
257

Average 2
1
monthly
hours
207
212
210
209
208
208
207
202
203
195
206

1 Excludes meal periods.
8 Median.
3 Includes data for nurses who did not indicate size of hospital in which
they ware employed.

APPENDIX A.

63

SUPPLEMENTARY TABLES

Table A— — A nnual p a id vacations after 1 year’s service, institutional and public health nurses, 1947
13.
Length of annual paid vacation

United New Middle Border
States England Atlantic States

South­
east

Great
Lakes

Middle
West

South­
west

Moun­
tain

97.7
8.5
51.7
4.0
29.0
1.7
2.8
2.3

94.0
8.0
57.3
9.3
18.7
.7
6.0
100.0
150

98.7
11.6
68.2
1.9
12.7
.2
4.1
1.3
100.0
636

97.5
65.0
5.0
12.5
2.5
12.5

93.7
3.8
62.0
3.8
8.9
8.9
6.3
6.3
100.0
79

Pacific

PERCENT OF INSTITUTIONAL NURSES

Nurses receiving paid vacations..................................
1 week..............._.....................................................
2 weeks. ...................................................................
3 weeks.-.......................... ......................................
4 weeks or 1 month.........-.....................................
Over 1 month
_
Other periods...... ........-................................ ........
Nurses receiving no paid vacation..............................
Total............................. .......................................
Number of replies to question...........................-........

96.9
10.1
47.8
8.7
26.0
.8
2.5
4.1
100.0
4,237

91.5
6.6
33.0
18.0
30.8
1.7
1.4
as
100.0
422

97.7
5.7
31.9
11.8
44.5
1.0
2.8
2.3
100.0
964

97.3
8.1
46.5
8.4
29.6
.7
4.0
2.7
100.0
297

97.1
4.2
50.9
8.0
29.0
.8
4.2
2.9
100 0

238

94.2
14.9
52.8
7.1
17.0
.8
1.6
5.8
100.0
1,090

93.9
17.4
51.8
9.1
14.8
.4
.4
6.1
100.0
264

100 0

176

PERCENT OF PUBLIC HEALTH NURSES

Nurses receiving paid vacations..................................
1 week__________________________________
2 weeks--............................................................... .
3 weeks. .................................................................
4 weeks or 1 month.................................................
Over 1 month
Other periods..........................................................
Nurses receiving no paid vacation..............................
Total_____________________ ________ ____
Number of replies to question........... -........................

97.2
2.6
39.5
8.4
33.9
6.6
6.3
2.8
100.0

1,008

99.2
15.4
4.1
65.0
11.4
3.3
.8
100.0
123

97.7
1.1

14.8
12.5
54.8
8.0
6.5
2.3
100.0
263

100.0
1.6
27.9
14.8
27.9
11.5
16.3
100.0
61

97.2
4.2
73.5
1.4
13.9
4.2
2.8
100.0
72

96.4
4.3
51.5
8.3
24.0
4.3
4.0
3.6
100.0
276

95.3
4.7
55.6
7.0
16.3
4.7
7.0
4.7
100.0
43

98.0
2.0
56.7
11.8
11.8
5.9
9.8
2.0
100.0
51

2.5

100.0
40

T abus A-14.—Paid sick leave after 1 year’s service, institutional and public health nurses, 1947
Amount of sick leave provided annually

United New Middle Border
States England Atlantic States

South­
east

Great
Lakes

Middle
West

South­
west

Moun­
tain

82.7
12.6
45.7
5.5
7.1
3.9
7.9
17.3
100.0
127

74.6
10.5
37.8
3.5
6.1
1.8
14.9
25.4
100.0
114

87.5
16.6
51.5
1.3
3.4
1.1
13.6
12.5
100.0
471

97.6
97.4
2.4
7.7
48.9
66.7
12.2
5.1
17.1
2.4
14.6
17.9
2.4
2.6
100.0 . 100.0
41
39

87.0
22.1
50.6

Pacific

PERCENT OF INSTITUTIONAL NURSES

Nurses receiving paid sick leave..................................
1 week.................... ...............................................—
2 weeks....................................................................
3 weeks.....................................................................
4 weeks or 1 month................................................
rtvftr 1 m on th
_ _ _
_ ________
Other periods...........................................................
Nurses receiving no paid sick leave............................
Total......................................................................
Number of replies to question.....................................

78.8
13.8
44.9
3.1
4.5
.9
11.6
21.2
100.0
3,371

79.1
13.8
52.6
5.2
3.2
.3
4.0
20.9
100.0
349

81.6
11.2
44.5
3.1
5.8
.1
16.9
18.4
100.0
797

85.1
14.5
45.4
4.3
7.7
2.1
11.1
14.9
100.0
235

79.5
9.9
49.2
5.8
6.4
1.2
7.0
20.5
100.0
171

73.5
15.7
41.3
2.6
2.3
1.2
10.4
26.5
100.0
910

62.4
14.2
32.5
1.0
6.1
8.6
37.6
100.0
197

PERCENT OF PUBLIC HEALTH NURSES

Nurses receiving paid sick leave..................................
1 week............. ...........— .......................................
2 weeks........................... .........................................
3 weeks.....................................................................
4 wpp.Its or 1 m on th
______________
Ovp.r 1 m on th
_
_____
Other periods................................ -........................
Nurses receiving no paid sick leave............................
Total.....................................................................
Number of replies to question------------ ---------------




95.0
10.6
53.5
4.9
6.7
2.3
17.0
5.0
100.0
884

97.2
11.0
61.5
5.5
6.4
1.8
11.0
2.8
100.0
109

93.8
8.9
47.1
4.9
8.0
3.6
21.3
6.2
100.0
225

96.8
6.3
36.5
7.9
12.7
4.8
28.6
3.2
100.0
63

98.2
17.5
66.6
1.8
7.0
5.3
1.8
100.0
57

96.6
9.9
57.4
3.9
5.2
1.7
18.5
3.4
100.0
232

90.2
9.8
53.6.
4.9
2.4
19.5
9.8
100.0
41

2.6
2.6

2.6
6.5
13.0
100.0
77

64

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

T able

A-15.—Insurance and retirement plans 1 provided institutional and public health nurses, 1947

Type of plan

United New Middle Border
States England Atlantic States

South­
east

Great
Lakes

Middle
West

South­
west

Moun­
tain

22.3
1.1
2.2
15.8
.5
1.6
1.1

21.6
4.2
15.6
1.2
.6

Pacific

PERCENT OF INSTITUTIONAL NURSES

Some benefits provided................................................
Accident and health insurance only....................
Life insurance only________________________
Retirement pensions only__________________
Accident and health and life insurance...............
Life insurance and retirement______ ________
Accident and health insurance and retirement
Accident and health and life insurance, and re­
tirement_______________________________
No benefits provided.....................................................
Total......................................................................
Accident and health insurance regardless of other
benefits......................... ..............................................
Life insurance regardless of other benefits________
Retirement pensions regardless of other benefits___
Number of replies to question.....................................

21.3
2.4
2.2
13.4
.6
1.3
.7
.7
78.7
100.0

16.6
2.6
11.2
.9
.6
.9
.4
83.4
100.0

20.0
1.5
2.2
13.5
.1
1.8
.7
.2
SO.O
100.0

20.6
.6
3.1
15.1
.9
.3
.6
79.4
100.0

28.7
5.1
2.0
17.2
.4
1.2
1.2
1.6
71.3
100.0

21.9
2.2
2.9
12.7
.6
1.8
.6
1.1
78.1
100.0

.7
.7
88.3
100.0

77.7
100.0

78.4
100.0

26.2
4.6
2.9
15.0
1.2
.9
.8
.8
73.8
100.0

4.4
4.8
16.1
4,677

4.8
1.9
13.1
464

2.5
4.3
16.2
1,082

2.4
4.6
16.0
319

8.3
5.2
21.2
255

4.5
6.4
16.2
1,255

3.1
2.1
8.6
293

2.7
4.3
18.5
183

4.8
1.2
17.4
167

7.4
5.8
17.5
659

19.0
19.0

11.7
1.7
1.4
7.2

PERCENT OF PURLIC HEALTH NURSES

Some benefits provided.............................................. .
Accident and health insurance only_________
Life insurance only________________________
Retirement pensions only----------------- ------Accident and health and life insurance_______
Life insurance and retirement -. _________ ..
Accident and health insurance and retirement -.
Accident and health and life insurance, and re­
tirement_______________________________
No benefits provided.....................................................
Total......................................................................
Accident and health insurance regardless of other
benefits___________________________________
Life insurance regardless of other benefits................
Retirement pensions regardless of other benefits___
Number of replies to question...............-....................
1Paid for in whole or in part by employers.




47.9
1.6
1.2
36.9
.6
3.9
2.8
1.9
52.1
100.0

45.4
2.1
.7
37.0
1.4
3.5
.7
54.6
100.0

53.3
3.3
1.2
35.3
1.2
6.0
3.0
3.3
46.7
100.0

35.7
1.4
5.7
1.4
2.9
52.9
100.0

6.9
7.6
44.5
1,174

6.3
2.8
42.6
141

10.8
11.7
47.6
334

5.7
10.0
45.7
70

47.1

44.3
1.3
34.1
7.6
1.3
55.7
100.0

53.9
.6
1.6
42.0
.6
5.3
1.9
1.9
46.1
100.0

33.3
1.9
29.5
1.9

25.5
5.9
11.7
5.9
2.0

66.7
100.0

74.5
100.0

81.0
100.0

49.5
2.1
42.0
1.1
3.2
1.1
50.5
100.0

10.2
1.3
43.0
79

5.0
9.4
51.1
308

1.9
1.9
31.4
54

2.0
11.8
19.6
51

19.0
42

6.4
2.2
47.4
95

65

APPENDIX A. SUPPLEMENTARY TABLES

T able A-16.— H ospitalization and medical care provided institutional and public health nurses , 1947 1
Type of plan

United New Middle Border
States England Atlantic States

South­
east

Great
Lakes

Middle
West

South­
west

Moun­
tain

Pacific

PERCENT OF INSTITUTIONAL NURSES

47.4
9.6
6.6
3.2
1.8
9.9
3.6
13.8
52.6
100.0

55.4
10.1
6.9
1.5
2.7
13.3
3.2
17.7
44.6
100.0

58.6
8.9
6.5
5.1
2.8
10.9
4.7
19.7
41.4
100.0

52.3
11.0
2.8
5.8
1.2
13.1
3.1
15.3
47.7
100.0

58.4
9.6
5.5
3.7
1.8
16.5
2.2
19.1
41.6
100.0

38.0
9.3
5.0
2.6
1.3
7.5
4.3
8.0
62.0
10C.0

40.7
10.7
4.6
2.9
1.0
9.1
2.0
10.4
59.3
100.0

53.5
11.7
3.1
2.0
1.0
11.7
5.1
18.9
46.5
100.0

36.4
7.1
4.8
1.8
1.2
6.0
3.6
11.9
63.6
100.0

39.0
10.2
6.4
L7
1.6
6.9
1.7
10.5
61.0
100.0

Hospitalization provided, regardless of other bene­
35.1
fits........................................................................
Medical care provided, regardless of other benefits..
30.5
Periodic physical examination provided, regardless
of other benefits.........................................................
24.7
Number of replies to question...................................... 4,840

43.8
35.7
30.5
475

42.3
40.4
33.7
1,117

40.6
37.3
22.4
327

47.0
41.5
28.6
272

26.1
22.4
18.6
1,292

31.2
24.4
18.0
307

43.3
37.7
28.1
196

26.2
23.3
21.5
168

29.2
20.8
20.2
686

7.8
2.0

9.4
4.7

5.8

4.7

13.7
7.3
1.1
2.1

Some benefits provided, ..............................................
Hospitalization only.................. ...........................
Periodic physical examination only....................
Medical care only. ................................................
Physical examination and hospitalization..........
Hospitalization and medical care........................
Physical examination and medical care..............
Hospitalization, medical care, and physical examination..... .......................................................
No benefits provided.....................................................
Total............... .....................................................

PERCENT OF PUBLIC HEALTH NURSES

16.6
1.3
9.1
.2
1.0
1.6
.2
3.2
83.4
100.0

Hospitalization provided, regardless of other bene­
7.1
fits.............. ................................................................
5.2
Medical care provided, regardless of other benefits.
Periodic physical examination provided, regardless
13.5
of other benefits..........................................................
Number of replies to question..................................... 1,171

Some benefits provided.................................................
Hospitalization only______________________
Periodic physical examination only.....................
Medical care only___________ _____________
Physical examination and hospitalization_____
Hospitalization and medical care. __________
Physical examination and medical care.......... .
Hospitalization, medical care, and physical ex­
am ination
No benefits provided....................................................
Total.....................................................................

24.0
8.0
1.3
2.7
1.3
10.7
76.0
100.0

9.2
1.3
1.3
1.3

15.3
1.6
7.9
1.6
1.3

7.5
5.6

1.4
82.3
100.0

21.5
2.1
13.4
1.5
1.2
.3
3.0
78.5
100.0

5.3
90.8
100.0

2.9
84.7
100.0

1.9
92.5
100.0

92.2
100.0

90.6
100.0

3.2
86.3
100.0

4.2
2.8
14.2
141

7.8
4.5
18.2
330

14.7
14.7
21.3
75

7.9
6.6
7.9
76

7.4
4.2
12.4
307

1.9
1.9
7.5
53

5.8
5.8
2.0
51

4.7
4.7
4.7
43

5.3
6.4
10.5
95

17.7
2.1
12.8
.7
.7

i Paid for in whole or in part by employers.

T able A—
17.—Insurance and retirement1 plans provided institutional nurses, by size of hospital, 1947
Size of hospital
Type of plan
Some benefits provided................................................
Accident and health insurance only....................
Life insurance only.............................-...................
Retirement pensions only.....................................
Accident and health and fife insurance
Life insurance and retirement..............................
Accident and health insurance and retirement..
Accident and health and life insurance, and re­
tirement
________ _______________
No benefits provided....................................................
Total............................ .........................................
Accident and health insurance provided, regardless
of other benefits.........................................................
Life insurance provided, regardless of other benefits.
Retirement pensions provided, regardless of other
benefits.......................................................................
Number of replies to question......................................
i Paid for in whole or in part by employers.




Less 50 to 100 to
All
149
sizes2 than 50 99 beds beds
beds

150 to
199
beds

200 to
299
beds

300 to
399
beds

400 to
499
beds

12.9
2.1
.6
7.7
.4
1.3
.8

14.8
1.1
2.0
10.2
.9
.4
.2
85.2
100.0

27.3
3.2
2.1
18.4
.4
1.4
1.4
.4
72.7
100.0

30.5
1.6
3.2
20.7
.8
2.6
.6
1.0
69.5
100.0

42.7
2.1
2.1
29.6
.7
3.9
2.5
1.8
57.3
100.0

52.0
.4
.7
44.2
L9
2.2
2.6
48.0
100.0

1.7
3.1
11.7
460

5.4
4.3
21.6
282

4.0
7.6
24.9
506

7.1
8.5
37.8
284

5.2
5.2
50.9
269

21.3
2.4
2.2
13.4
.6
1.3
.7
.7
78.7
100.0

13.2
3.3
1.6
6.3
.5
.9
.3
.3
86.8
100.0

14.4
4.1
1.7
7.3
.2
.5
.3
.3
85.6
100.0

13.4
3.6
1.0
6.6
1.0
.6
.2
.4
86.6
100.0

87.1
100.0

17.3
1.6
4.6
8.2
.9
.6
.6
.8
82.7
100.0

4.4
4.8
16.1
4,677

4.4
3.3
7.8
455

4.9
2.7
8.4
634

5.2
3.0
7.8
526

3.3
2.3
9.8
480

3.9
6.9
10.2
647

500 to 1,000 to 2,000
999
1,999 beds or
beds beds more

2 Includes data for nurses who did not indicate the size of the hospital in
which they were employed.

66

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES
T able A-18.—Duties of institutional head and general staff nurses1—Percent of

time spent on major groups of duties

Preparing and givin g m edication, changing dressings, givin g aseptic treatm ents,
takin g tem perature and pulse, ch eckin g m edications and supplies, preparing
patients for operating r o o m ...................... ....... ....................... ..............................................
A ssisting in operations and deliveries........................................................... ........... .............
T e a ch in g or supervising stu den ts........................ ................. ..................................................
Supervising registered nurses_____________________________ ______ ______ ____ ________
T e a ch in g or supervising nonprofessional w orkers______ ___________________________
W ritin g nurses’ notes______ ________________________ _____________________ __________
B ath in g and feeding patients, givin g back rubs, m aking beds, takin g m eals to
patients, answering lights, tak in g patients to appoin tm ents, ch ecking linens
and household sup p lies........ ................. ....... ......... ............. ...................................................
Clerical w ork (except nurses’ n o te s )___________________________ _____ _________ _____
O ther d u ties........ ......................... ............................. ................................................................ ..

18.0
9.7
12.5
7.3
10.9
8.6

.. .

36.0
3.8
7.5

100.0

100.0

856

______

26.8
9.0
1.9
.3
4.1
10.6

13.7
10.9
8.4

T o t a l........................................................................................................................................
N u m b e r o f replies to question _ _ _

General
staff nurses

B ead
nurses

D u ties

1,919

1 Based on report from each nurse covering 1 day in February 1947.

T able A-19.—Duties of institutional nurses, by size of hospital1—Percent of time spent on major groups of duties
Size of hospital
Duties

Less
A ll2 than 50 to 99 100 to 150 to 200 to 300 to 400 to 500 to 1,000 to 2,000
sizes 50 beds beds 119 beds 199 beds 299 beds 399 beds 499 beds 999 beds 1,999 beds or
beds more

Preparing and giving medication, changing dress­
ings, giving aseptic treatments, taking tempera­
ture and pulse, checking medications and sup­
plies, preparing patients for operating room...........
Assisting in operations and deliveries.........................
Teaching or supervising students................................
Supervising registered nurses......................................
Teaching or supervising nonprofessional workers__
Writing nurses’ notes____ ________________ ____
Bathing and feeding patients, giving back rubs,
making beds, taking meals to patients, answering
lights, taking patients to appointments, check­
ing linens and household supplies............................
Clerical (other than nurses’ notes)..............................
Other duties....................................................................
Total......................................................................
Number of replies to question...................—...............

20.5
11.6
7.6
4.8
7.2
8.3

21.0
17.7
1.1
2.1
8.1
9.3

21.7
16.0
3.4
4.1
6.8
9.5

19.2
15.0
6.7
6.4
7.1
8.4

22.5
5.2
8.0
6.0
10.7
8.3

23.9
3.3
7.8
7.2
13.2
9.2

2.9
7.4
9.7
100.0
4,214

28.7
4.2
7.8
100.0
472

25.4
3.8
9.3
100.0
598

21.2
20.6
22.3
21.7
21.8
23.6
21.9
11.3
9.5
9.2
6.1
10.5
6.6
7.7
6.8
9.7
9.2
9.9
11.0
10.1
11.9
100.0 100.0 100.0 100.0 100.0 100.0 100.0
509 | 460 | 352 j 442 | 288 | 491 | 303

16.1
10.5
8.8
100.0
280

i Based on report from each nurse covering 1 day in February 1947.

T able

19.2
13.6
10.8
5.4
5.3
7.3

17.7
10.2
11.0
4.4
5.7
7.8

20.8
8.8
9.0
3.9
7.6
7.2

19.5
9.2
10.7
4.6
5.5
8.5

22.0
9.6
8.8
5.5
6.9
7.4

1

2 Includes data for nurses who did not indicate size of hospital in which they
worked.

A-20.—Number of nurses replying to questionnaire, by region and employment status
Employed in nursing

Region
United States................................................
New England...............................................
Middle Atlantic............................................
Border States.................................................
Southeast.......................................................
Great Lakes...................................................
Middle West................ .................................
Southwest......................................................
Mountain.......................................................
Pacific.............................................................
Region not reported...................................




All replies
21,707
2,327
5,157
1,323
1,152
5,689
1,358
960
807
2,899
35

All fields Institu­
tional
12,609
1,260
2,975
827
718
3,485
746
579
442
1,546
31

5,458
551
1,239
362
305
1,443
351
226
192
771
18

Private
duty
2,838
323
750
203
146
734
163
160
90
261
8

Public Industrial
health
1,343
169
372
85
89
343
66
54
50
113
2

843
73
199
53
34
353
27
23
14
67

Office
1,034
47
181
58
69
284
73
59
45
217
1

Nurse
educators
450
51
99
38
29
129
25
22
15
41
1

Other
643
46
135
28
46
199
41
35
36
76
1

Not em­
ployed in
nursing
9,098
1,067
2,182
496
434
2,204
612
381
365
1,353
4

APPENDIX B

Scope and Method of the Study
The survey of registered professional nurses’
working conditions, job attitudes, and reasons for
leaving their profession summarized in this report
was conducted by means of a mail questionnaire
sent to a representative group of nurses through­
out the United States. Approximately 47,000
nurses were sent questionnaires.1 Of these,
21,700, or 46 percent, returned usable replies.2
Those who filled out questionnaires represent
about 5 percent of the estimated total of 400,000
or more currently registered nurses in the United
States.
Coverage and Method of Selection

The survey was limited to those who have ful­
filled the requirements of a State Board of Nurse
Examiners for practice as an “R. N.” or registered
professional nurse. It excluded both student and
practical nurses. Both those who were still
active in nursing and those who were inactive but
had maintained their current registration as nurses
were included.3 Among those still active were in­
cluded members of all branches of nursing.
The persons to be sent questionnaires were
selected from lists of currently registered nurses
maintained by Boards of Nurse Examiners, except
in five States where nurses were not required to
register currently. In four of these (Maryland,
1 Slightly over 50,000 questionnaires were mailed out but about 3,000 of these
were returned because of out-of-date addresses.
2 Approximately 750 additional questionnaires were returned but did not
prove to be usable because the information provided did not permit classifica­
tion of the respondents according to employment status or because they were
received too late for inclusion in the survey.
s Many who are no longer active in nursing maintain current registration.
This fact explains the difference between the estimate of 250,000 actively
employed, given in pt. I, and the total registration of 400,000. No attempt
was made to study those who had not kept up this registration.




North Carolina, Ohio, and Wyoming) names were
chosen from membership lists of the State Nurses'
Association. In the fifth (South Carolina) an
official list of nurses who had registered or reported
addresses since 1942 was used.
One out of every 10 names on the official State
lists (excluding only members of religious sister­
hoods) was selected;4*nurses actively engaged in
nursing and those who had left the profession,
those in and outside the armed services, and those
living in and outside the State of registration were
included in the study. Names were selected
regardless of sex or color, but the number of replies
from men and from Negro nurses was not large
enough to warrant presentation of separate infor­
mation for them.6
Since many nurses maintain registration in more
than one State, the selection of 1 out of 10 from
each State list actually resulted in sending questtionnaires to over a tenth of all currently registered
nurses in the country as a whole. The proportion
for the United States as a whole was probably
between one-eighth and one-tenth.
Representativeness of Returns

Replies were received from all States, the
District of Columbia, Alaska, and Hawaii.6 The
4 Where the membership list of the State nurses' association was used,
enough names were selected to represent one-tenth of the estimated total
number of nurses in the State regardless of the size of the association member­
ship.
6 They were, of course, included in all data presented in the report.
4 Questionnaires were sent to Alaska and Hawaii but returns from Alaska
were not numerous enough to warrant inclusion in the study. Data on
Hawaii are not included in United States totals but are discussed separately
where the number of replies was large enough to warrant their presentation.
Puerto Rico and the Virgin Islands were not studied.

67

68

ECONOMIC STATUS OF REGISTERED PROFESSIONAL NURSES

proportion of returns was about the same (45 to
51 percent) from all regions except the Southeast
and Southwest, where returns were only 37 and
40 percent, respectively.7 With some exceptions,
the ratio of replies was comparatively uniform
among States within each region. A higher pro­
portion of nurses in large than in small cities
replied to the questionnaire.8
As indicated previously, representatives of all
fields of nursing were included in the survey.
The method of selection from State records did
not assure inclusion of the same proportion of
nurses in each field of nursing, and a comparison
of returns with available information on the total
number in each major field indicates that the
proportion of replies actually did vary.
Questionnaires were answered by 12,609 active
nurses—5,458 institutional nurses (roughly 4 per­
cent of all such nurses) ;9 2,838 private duty nurses
(about 5 percent of this entire field); 1,343 public
health nurses (over 6 percent of this branch of the
profession); and 450 nurse educators, 843 industrial,
1,034 office, and 643 other nurses (estimated to be
about 10 percent of all nurses in these fields).
The remaining 9,098 questionnaires came from
those who had maintained their registration as
nurses but were not employed in the profession at
the time of the study.
The differences in returns just described appar­
ently did not seriously affect the validity of the
results either for individual regions or for the
country as a whole, in view of the amount of vari­
ation in earnings and other working conditions and
in opinions.10* In order to minimize the effect of
these differences in coverage as well as the influ­
ence of errors that are likely to arise in replies to a
mail questionnaire, the averages presented are
(unless otherwise stated) medians rather than
weighted means. These medians are the values
below and above which half the replies fall.
7 These proportions are the ratio of usable questionnaires to the total num­
ber of the questionnaires that were actually delivered to nurses. The ratios
would, of course, be slightly lower if the proportion of usable returns to the
number actually mailed out (including those undelivered because of changed
addresses) were substituted.
* While about 1 in 3 questionnaires went to cities of 260,000 or more, about 2
out of 6 replies came from such c ite .
• Among institutional nurses, replies were received from about 5 percent of
the head and assistant head nurses and only 3 percent of the general staff
nurses.
10 It is possible that comparatively small returns from some of the Border
and Southeastern States with comparatively low standards would tend to
raise slightly but not seriously the average picture shown for these two
regions.




Tabulation Methods

The number of responses varied from one ques­
tion to another, and answers falling in each cate­
gory are expressed as percentages of the total
number of usable replies to the question under
consideration instead of being related to the total
number of replies to the questionnaire.11 No
attempt was made to exclude from the survey
those questionnaires that did not provide usable
information on all items. Similarly, because of the
relatively large volume of replies, no effort was
made to edit the questionnaires to obtain con­
sistency in answers to related questions.
The methods used in determining the propor­
tion of nurses dissatisfied with various aspects of
their work are described in the chapter on opinions
(p. 36). In general this method should avoid
any overstatement of the extent of dissatisfaction.
It is believed that the percentage of replies to the
inquiry was high enough to prevent overstatement
of dissatisfaction resulting from a tendency for
participants in the study to be more dissatisfied
than those who failed to return their question­
naires.
Period Studied

The questionnaires were mailed out during the
last week in January and the first week in Febru­
ary 1947, and only those returned by the middle of
March were summarized. Information on earn­
ings and hours refers to October 1946 since data
for November and December might have been
affected by holidays to the extent that arrange­
ments are made to give some nurses time off on
each holiday at the expense of longer hours for
others during that time.
Annual Earnings

In order to reduce the size of the questionnaire,
information was not collected on annual earnings.
An annual earnings figure for the period from
October 1945 to October 1946 or for the calendar
year of 1946 would have covered an interval of
considerable change in salary scales and hence
would have been of limited value. A rough
11 It is possible that this procedure leads to some overstatement of the
prevalence of such conditions as split shifts and time on call, since nurses not
replying to these questions may not have understood them because they had
not encountered the practices.

APPENDIX: B.

approximation of an annual salary rate can be
obtained by multiplying the monthly average
shown for October by 12. (The monthly average
earnings data include nurses who did not work
during October because of illness but who were
attached to a specific nursing field, as well as
private duty nurses who had been on a case
within 3 months regardless of whether they worked
during October. Those who were unemployed
but seeking work in nursing were not included,
but. in this period of full employment they were
not sufficiently numerous to affect the average
appreciably.)
Available Information

Because of the relatively small proportion of
nurses studied it was necessary to present some
data based on a comparatively small number of
replies. The alternative would have been to




69

SCOPE AND METHOD OF STUDY

omit most of the tabulations of data by region
and all discussion of city data as well as many of
the other break-downs presented.12 In any case
it was necessary to limit the information for
individual cities to institutional and private duty
nurses.
In addition to the detailed data presented in
the tabulations, other information was collected
that is not published because of printing limita­
tions. Should readers of the report find need for
additional data the Bureau of Labor Statistics
will supply the information if it has been tabulated
and is sufficiently reliable to warrant presentation.
A limited number of copies of the questionnaire
are available on request for those interested in the
exact wording of the questions.
i* The number of replies on which a given figure was based is available
on request; space limitation prevents printing much of this information
in the report.

U. S. GOVERNMENT PRINTING OFFICE: 1948


Federal Reserve Bank of St. Louis, One Federal Reserve Bank Plaza, St. Louis, MO 63102