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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.*Il 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_______________________________ Page III 1 1 1 1 2 2 3 3 4 5 5 5 5 6 6 6 6 8 10 10 10 12 14 14 16 16 17 18 19 19 20 22 23 23 24 25 26 26 27 28 29 31 33 34 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--------------- ---------- --------------------- 7 7 8 9 9 11 12 13 13 14 17 17 18 21 21 22 23 24 24 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____________ Page 25 26 27 28 29 29 31 32 33 38 48 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___________________________________________________________ - 57 58 58 59 59 60 60 60 61 61 62 62 63 63 64 65 65 66 66 66 34 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 56 24 8 4 4 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 Age 7 ACTIVE NURSES of active and inactive nurses, 1947 Percent of active nurses Percent of inactive nurses Nurse Private Public Indus All* Institu tional duty health trial Office educa tors Not employed Em Intend Notin Unable All ployed outside ing to tending to work, to re nursing A1P House wives return to turn to or re 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 Private Public Indus A ll1 Institu tional duty health trial Office educa 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 to work, to re nursing Ain House wives return to turn to or re 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 Private Public Indus A1U Institu tional duty health trial Office educa 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 to work, outside to re nursing All i House wives return to turn to or re 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 tion than in other fields of nursing (table 4); it is dependents.12*18 possible that veterans planning to enter the latter 11 U. S. Bureau of the Census, Sixteenth Census of the United States, 1940: Population, vol. Ill, pt. I. Estimate is based on exclusion of student nurses field were themselves taking advanced education from census data. Also excluded are those who 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 13 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 Private Afi fields8 Institu 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 A n fields* Institu Nurse Office educators tional educators 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 2.0g 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*3. T____T______ __________________ Living in hospital quarters Living outside hospital quarters . _ ___ Private duty * ___ Public health _ _ Industrial____ _ _ Office. _ _ Nurse educators. _ ___ _ __ ___________ _ Num United New Mid South Great Mid Moun ber of Eng dle Border dle South States east Lakes West west tain Pacific replies States land Atlan 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 00182 $198 177 183 169 00182 168 157 170 154 163 174 170 163 197 168 00195 00163 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 413*..................................................................................... Public health: All positions _ ____ _ School nurses _ ... _ ______ _._ Staff muses _ __ _ _____ Industrial ________ _ _ _ Office _ _ _ _ _ _ _ _ _ Nurse educators: Living in hospital quarters___________________________ Living outside hospital quarters_______________________ Institutional: Living in hospital quarters _ _ _ _ _ _ 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, NewWashington. Mexico, Utah, and Wyoming; and Pacific—California, Nevada, Oregon, and 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 15 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,n and under 139.9 cents.............................................................. 140 and under 149.9 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 .1.4 1.8 100.0 679 $1.11 Nurses living in hospital All Nurse Institu Nurse Office educators fields3 tional educators 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................................................................................. $1 05— $1 10 ___ _ ________ ________ $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 Nurse All Insti educa fields2 tution 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.1817 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 In evaluating the variation in earnings with education, it should be borne little influence on earnings.18 Aside from the in18mind that, except for public health nurses and nurse educators, a very large have no graduate education. No attempt was made to analyze relationship within individual fields between majority the variation in earnings of private duty nurses with age, experience, or edu earnings and age, experience, and amount of cation; their hourly rates are relatively uniform and are determined pri marily by community practice. In a period when work is plentiful an education, those fields characterized by the lowest analysis variation in their monthly earnings or hours would probably average age and years of experience (office and not reflectof thedifferences in employment 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 Indus tu Public 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 Nurse Actual monthly hours All Insti dus Office edu tu vate Public nurses2 tional on duty duty health trial 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.**24 With the short 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 difference in hours with size of Coast than in other regions. In three fields, Middle communitysome and size of hospital. Nurses in Atlantic nurses reported slightly shorter hours, but Federal hospitals had the shortest scheduled in other branches of the profession hours in that and the shortest actualboth hours. among region were not notably short. There was no Federal nurses, those in the armedHowever, 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 ' | Mid- South Moun Pacif Lakes West 4 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......................................... Pub Nurse All Insti tu lic Indus Office edu fields4 tional health trial 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 All Insti Public Indus Office Nurse tu health edu trial fields i tional 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 Indus tu Public edu health trial 2 Office2 cators fields2 tional 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 Indus edu tu Public health trial Office cators fields2 tional 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 Public Indus Nurse All Insti tu vate health edu fields2 tional trial Office cators duty 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 Opinions37 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 12 of institutional and public health nurses and 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—2 .— Maintenance 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 L84 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. A 0 O 2.7 24.5 69.2 5.5 2! 7 . QJ7 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 Number of Average Number of Average Number of monthly monthly replies earnings replies earnings replies monthly 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 Average Number Average Number Average Number Average Number Average Number monthly monthly monthly monthly of replies monthly earnings of replies earnings of replies earnings of replies earnings of replies 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 1,509 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 72 382 151 162 106 487 164 168 1 Median. 3 Includes cash paid in lieu of maintenance but excludes the cash equivalent of maintenance provided by employers. $161 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 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 Average Number Average Number Average Number Average Number Average Number monthly monthly monthly monthly of replies monthly earnings of replies earnings of replies earnings of replies earnings of replies 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 All sizes Under 25,000 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 4.3 .8 6.4 2.6 .8 60.1 4.7 2.9 10.1 1.0 6.3 100.0 2,483 25.000 and under 100.000 100.000 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 Great Lakes Middle West 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 _ __ _ 910hours a day and 54 a week 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..................................... .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 Non State County Munic All em Federal govern ipal govern govern govern ployers 3 Govern ment mental ment ment ment 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 21 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—13.— A nnual p a id vacations after 1 year’s service, institutional and public health nurses, 1947 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........................... ......................................... 34 weeks..................................................................... 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 50 99 beds 149 sizes2 than 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........ ......................... ............................. ................................................................ .. 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 ______ 18.0 9.7 12.5 7.3 10.9 8.6 26.8 9.0 1.9 .3 4.1 10.6 13.7 10.9 8.4 36.0 3.8 7.5 100.0 100.0 856 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 to 2,000 A ll2 Less 50 to 99 100 to 150 to 200 to 300 to 400 to 500 to 1,000 1,999 beds or sizes 50than beds beds 119 beds 199 beds 299 beds 399 beds 499 beds 999 beds 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
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