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-s7^
The Outlook
Women
as
PRACTICAL NURSES
^
and
auxiliary workers on the nursing team
MEDICAL SERVICES SERIES
Bulletin No. 203-5 (1953)
U.S. DEPARTMENT OF LABOR
J ames P. Mitchell, Secretary
ROAR03
WOMEN’S BUREAU
Frieda S. Miller, Director
This bulletin deals principally with . .
I. THE PKACTICAL NURSE who is “a person trained to
care for selected convalescent, subacutely, and chronically ill
patients, and to assist the professional nurse in a team rela
tionship, especially in the care of those more acutely ill. She
provides nursing service in institutions, and in private homes
where she is prepared to give household assistance when
necessary. She may be employed by a private individual,
a hospital, or a health agency. A practical nurse works only
under the direct orders of a licensed physician or the super
vision of a registered professional nurse.” (5)
Some practical nursing titles are: Licensed Practical Nurse,
Trained Attendant, Licensed Vocational Nurse, Licensed
Nursing Attendant, Certified Practical Nurse, Eegistered
Practical Nurse.
. . .
and adds some notes about
II. Auxiliary Workers on the Nursing Team
UNITED STATES DEPARTMENT OF LABOR
AMES P. MITCHELL, SECRETARY
WOMEN’S BUREAU
FRIEDA S. MILLER, DIRECTOR
The Outlook ft
Women
as
Practical Nurses
auxiliary workers on the
nursing team
Bulletin of the Women’s Bureau No 203—5 (1953)
M.edical Services Series
U. S. GOVERNMENT PRINTING OFFICE
WASHINGTON : 1953
For sale by the Superintendent of Documents, U. S. Government
Printing Office, Washington 25, D. C.
Price 40 cents
This is Bulletin 203—5 in the
MEDICAL SERVICES SERIES, REVISED
No. 203-1
The Outlook for Women as Physical Therapists.
No. 203-2
The Outlook for Women as Occupational Therapists.
No. 203-3
The Outlook for Women in Professional Nursing Occupations.
LETTER OF TRANSMITTAL
United States Department of Labor,
Women’s Bureau,
Washington, October 26, 1953.
Sir : I have the honor to transmit a bulletin on the outlook for wom
en as practical nurses and auxiliary workers on the nursing team.
This bulletin supersedes an earlier report of the same number, Wom
en’s Bureau Bulletin 203-5, issued in 1945. It accounts for an im
portant and substantial group of occupations in nursing service which
are not represented in Women’s Bureau Bulletin 203-3, dealing with
the outlook for women in professional nursing.
Since 1945, profound changes have taken place in nursing educa
tion and nursing service, along with a continuing shortage of pro
fessional and auxiliary nurses. Among all classes of nursing
personnel, the outlook for practical nurses has changed most remark
ably in the past decade, with unprecedented developments in the in
crease of training opportunities and new requirements in many States
and the several Territories for licensing and standards of practice.
Because new developments in nursing occupations are expected to
continue for some time, a number of questions about auxiliary nursing
personnel have been left open. It can be stated with assurance, how
ever, that it is important for women entering practical nursing to set
their goals as high as possible in vocational training and to seek em
ployment that will continuously enrich, as well as make the best use
of, their experience and skills. For women who are already working
as practical nurses, it is essential to keep pace with current develop
ments and to try to meet changing requirements.
Many persons and agencies concerned with the Nation’s need for
nursing personnel have contributed to the information and point of
view in this bulletin. Acknowledgment is made for these services
and for illustrations used in the text on page IV.
This bulletin was prepared and written by Lillian V. Inke, Chief
of the Employment Opportunities Branch in the Women’s Bureau
Research Division, of which Mary N. Hilton is Chief. Grace E.
Ostrander assisted with a part of the research. The Statistical Branch
of the Research Division provided substantial help in collecting data.
Respectfully submitted.
Frieda S. Miller,
Director.
Hon. James P. Mitchell,
Secretary of Labor.
in
Acknowledgments . . .
are made to a great many persons and agencies for assistance
in preparing this bulletin, including:
(1) Sources to which reference is made in the text (listed in
appendix D);
(2) Interviews and correspondence with nursing organiza
tions: American Nurses’ Association, National Association
for Practical Nurse Education, National Federation of
Licensed Practical Nurses, National League for Nursing,
Licensed Practical Nurses of New York, Inc.; with the Nurse
Placement and Medical Center of the New York State Em
ployment Service (affiliated with USES) ; and with staff in
many Government agencies, particularly the U. S. Public
Health Service, Department of the Army, Department of
the Navy, Bureau of the Census, Civil Service Commission,
Veterans’ Administration; and
(3) Valuable advice, the use of unpublished materials, and
special consultation from Margaret F. Knapp, R. N., and
Louise Moore of the Division of Vocational Education,
Office of Education, U. S. Department of Health, Education,
and Welfare; from Mrs. Margaret Carroll, R. N., of the
American Nurses’ Association, and Mrs. Mary R. Shields,
R. N., of the National League for Nursing.
(4) Illustrations, contributed by—
Central School of Practical Nursing, Cleveland, Ohio (fig. 3b).
Instructive Visiting Nurse Association, Richmond, Va. (fig. 3a).
National Association for Practical Nursing Education (fig. 2a).
St. Anthony School of Practical Nursing, Denver, Colo. (fig. 5).
Trade High School, Springfield, Mass, (cover picture, fig. 4a).
U. S. Department of the Army, Office of the Surgeon General (figs. 1,
2b, 2c, 4b, 4c, 6).
Visiting Nurses Service of New York (lig. 3c).
xv
CONTENTS
Part T: PRACTICAL NURSES
Page
The Job of the Practical Nurse
Job duties
Job variations___________
Job requirements in brief______ _____ _
_____________________
The job trend
Employment Outlook for Practical Nurses________________
_____
How many practical nurses in the civilian labor force?_____________
Where practical nurses work
The demand for practical nurses
______________________
Outlook for minorities, older women, and married women__________
Conditions of Employment ___________________________
___ ____
Earnings of practical nurses ____________________________________
Salary trend
16
Hours
17
Licensing__________________________________________ ____________
The trend in licensing
19
Social security
21
Training for Practical Nursing__
Types of schools_____________________________________
School approving and accrediting agencies
22
Length of courses
24
Course content
24
Inservice training in the Armed Forces
26
Extension courses
27
Combined academic training and practical nursing_________________
Costs of training
The outlook for training
29
Race, marital status, and age in relation to training________________
A Few Career Suggestions
31
To be or not to be—a practical nurse
31
Selecting the school
32
Finding the job_________________________________________________
Trade-marks
34
Joining a practical-nurse organization
34
1
1
2
3
4
6
6
7
10
13
14
14
18
22
22
28
28
30
33
Part II: AUXILIARY WORKERS ON THE NURSING TEAM
Who Are the Auxiliary Workers?
37
Nursing Aide as an Entry Job in Hospitals
39
Increase in Nursing Aides in Hospitals
40
Earnings and Hours of Auxiliary Nursing Workers in Hospitals_________
The Future for Auxiliary Workers on the Nursing Team__ _____________
Suggestions to Women Interested in Auxiliary Nursing Jobs____________
v
41
42
44
VI
CONTENTS
APPENDIX
1. Job Descriptions for Practical Nurse and Nurse Aide in Hospitals____
2. Approved Practical Nurse Training Programs in United States and
Territories, September 1952_______________________________ _____
3. Practical Nurse Positions in the Federal Civil Service________________
4. Bibliography
59
Chart:
Types of practical nurse training programs
Page
31
49
57
25
Illustrations:
1. The practical nurse works on the same team as the professional
nurse, although her job is differentFacing
2. In the hospital, practical nurses can carry a large share of bedside
nursing care
3. Practical nurses visit homes to give nursing care and instruction
in home nursing methods
11
4. Today’s practical nurses go to school before they practice________
5. Practical nurse students learn clinical specialties in hospital
practice
32
6. Auxiliary workers do hundreds of important service jobs in the
38
hospital
1
8
23
Figure 1. The practical nurse (left) works on the same team as the
professional nurse, although her job is different.
PART I.—PRACTICAL NURSES
THE JOB OF THE PRACTICAL NURSE
Job Duties
The core of the practical nurse job consists of duties in bedside
nursing and patient-centered care, and the practical nurse stands oc
cupationally next in skill and training to the general duty professional
nurse. She is required to perform tasks for maintenance of the
patient’s surroundings and equipment, but according to well-estab
lished methods and standards for nursing service, and not in the usual
sense of housekeeping. The more exacting part of her job, however,
consists of duties related to care and treatment of the patient.
Based on a guide list drawn up by nursing experts (28) the duties
of the practical nurse may include:
(1) Caring for patient unit: making beds; caring for hospital equipment;
caring for clothing, valuables, flowers, and personal equipment of
patient; practicing medical asepsis ;
(2) Carrying out personal hygiene measures for patient: giving baths,
rubbing back, caring for mouth and teeth; caring for nails, hair and
scalp, nose, and elimination; feeding patient; dressing and undressing
patient;
(3) Providing for and maintaining physical and mental well-being of
patient, including comfort, safety, and recreation ;
(4) Planning, preparing, and serving foods: planning menu, preparing
foods, preparing meals, spending and accounting for funds in the home;
(5) Carrying out or assisting with routines in diagnosis: observing and
recording signs and symptoms, weighing and measuring patients, col
lecting specimens, assisting physician or technician in carrying out
diagnostic procedures, testing urine;
(6) Preparing surgical supplies and equipment: preparing dressings for
sterilization, sterilizing instruments and equipment for surgical treat
ments, and making common solutions;
(7) Carrying out treatments : putting patients in prescribed body positions;
giving medications and injections; applying and removing bandages,
binders, and adhesive tape; applying simple treatment, using equip
ment such as ultraviolet lamp, hot and cold applications, etc.;
(8) Rendering special types of services: assisting in preparation of patient
for surgical operation, caring for selected patients recovering from
anesthesia, receiving patient and transferring patient to another unit,
assisting with discharge of patient from hospital, arranging for last
rites for dying patients, caring for body after death; and
(9) Providing general first-aid and emergency care for patients based upon
standard procedures as set forth in first-aid training courses.
259707°—5:
2
1
2
OUTLOOK FOR WOMEN
Duties such as “assisting in preparation of patient for surgical
operation” and “caring for selected patients recovering from anes
thesia” are to be performed only when the practical nurse is under
the direct supervision of a professional nurse or when a selected
patient has been placed under her care.
Today’s candidate for the practical nurse career in 40 States,
Hawaii, and Puerto Rico which have established licensure must pre
pare for employment by completing training in an approved school
of practical nursing. In 1953 it has become almost universally recog
nized that practical nurse training should consist of 1 year of com
bined classroom work and supervised experience in hospitals. In
earlier years, the practical nurse became, known as “practical” because
she learned nursing skills through practice on job assignments. Thus,
her preparation was left largely to chance.
The Joint Committee on Practical Nurses and Auxiliary Workers
in Nursing Service1 has recommended that the yardstick to measure
the amount and kind of nursing care which a practical nurse may give
is “primarily the 'patient’s condition, not the type of duties in them
selves” (5) ; and also recognizes that the practical nurse’s job duties
may change and shift for a single patient, depending upon the course
of the illness. Both the physician and the professional nurse deter
mine the kind of nursing care which the practical nurse may provide,
particularly in cases of acutely ill patients.
Job Variations
Depending upon the job setting and the particular patient, the
duties as listed will vary considerably. If the practical nurse works
in a hospital, some of the housekeeping duties, such as making beds
and caring for equipment, may be taken over by an auxiliary nursing
worker such as a nursing aide or ward maid. Obviously, the duties
of planning and preparing food apply to a private home setting; in
the hospital, a nursing aide or diet maid may serve the meals which
are prepared in a central diet kitchen.
When the practical nurse is employed by a health agency or hospital
she may be assigned to a team supervised by a registered professional
nurse. Because the nursing-team pattern differs from one agency
to another, and even from one unit to another within a hospital, there
are innumerable combinations of job duties for the practical nurse,
depending upon the number and kind of workers on the team, and
how they are assigned to nursing care, housekeeping, or clerical func
tions. (See part II, p. 37.)
1 In 1953, the NLN Committee on Practical Nursing and Auxiliary Nursing Service,
incorporated into the National League for Nursing, is the Joint Committee’s successor, and
current reference is hereafter made to it as the NLN Committee.
PRACTICAL NURSES
3
It is possible for the practical nurse to work in a private home
setting as a nursing-team member. The Visiting Nurse Service of
New York has used practical nurses in this way since 1942, and their
team pattern consists of a nursing supervisor, a professional staff
nurse, a practical nurse, and a clerk {25). Each team is assigned to
a district and has a specific patient load. Duties of the practical nurse
in relation to each patient are worked out in consultation with the
supervisor by the professional nurse who maintains contact with the
attending physician.
When working for a private employer, the practical nurse accepts
considerable responsibility for following the attending physician’s
instructions, and she must have enough judgment and knowledge to
recognize when the nursing situation is beyond the scope of her train
ing and skill. There are many private duty jobs, however, in which
the physician’s supervision is comparatively routine, as in the care of
a chronic invalid, or an aged person where nursing requirements do
not change much from time to time.
Unless she is under agency supervision, the practical nurse in private
employment may find it necessary to guard herself against the assign
ment of household tasks to the exclusion of opportunity to practice
nursing.
In doctors’ offices the practical nurse assists the physician or a
professional nurse in the examination of patients and in giving simple
medications and treatments; she may also be required to carry out
simple laboratory test procedures, take care of laboratory and other
medical equipment, and perform some routine clerical duties.
Industrial establishments which employ professional nurses in their
employee health and medical departments also use practical nurses2
as assistants to professional nurses. Their duties vary from auxiliary
nursing duties for employees at the plant or place of business, to
home visiting services, but they are always under close supervision,
as in other job settings.
Job Requirements in Brief
Minimum requirements for practical nurses are established by
State boards of nurse examiners and vary from State to State. Most
States require at least 1 year of training in an approved school of
practical nursing; Connecticut allows a 9-month course of practical
nursing, and Massachusetts requires 15 months.
2 In 1947, the job definition for practical nurse as originally set forth by the Joint
Committee on Practical Nurses and Auxiliary Workers in Nursing Service included assign
ment of practical nurses in industrial health units, but this was eliminated by 1951.
Nevertheless, practical nurses are employed in industry, although not extensively.
4
OUTLOOK FOR WOMEN
In some States, practical nurses who have been working at their
vocation over a period of years and who have not obtained formal
training are not excluded from practice if they are able to meet re
quirements on the basis of experience and personal qualifications, as
set forth by many State practice acts.
Licensing of the practical nurse is becoming a necessity in most
areas of the Nation, and women who wish to enter, or who are prac
ticing in this occupational field, are encouraged to obtain licenses.
If a practical nurse has not obtained the formal training offered in
recent years, she should be able to provide evidence of her proficiency
by passing the licensing requirements in her own or some other State;
if she is not licensed on the basis of her experience or training, she is
likely, in time, to be barred from accepting a number of employment
opportunities.
Both training and licensing are discussed more fully in later sections
of this bulletin.
The Job Trend
Since World War II the practical-nurse occupation has undergone
notable change. The job itself was defined in new terms, first in
1947, and again in 1951, by professional nursing organizations (5).
There have been new developments in standards of work performed
and in vocational preparation, as well as widespread interest among
States in establishing or improving legal regulations governing the
practice of the occupation. Most of these changes arose out of the
wartime experience of hospitals and health agencies in their efforts to
make the best possible use of a short supply of nursing personnel.
Because a great many changes have taken place in relatively few
years, a wide divergence between minimum and maximum standards
for practical-nurse training and employment may be found, and will
undoubtedly continue to exist for some time among various States
and even in the same cities, among different employers. The public,
which is hardly aware of occupational changes to the same degree
as the workers who are primarily concerned, has a deeper personal
interest in nursing service occupations than in many kinds of work.
This interest, together with the anticipated continuing shortage of
all classes of nursing workers, will undoubtedly help to hasten the
changes already begun, and maximum standards for practical nursing
in 1953 may become minimum standards within a few years.
Changes which have taken place in practical nursing are advan
tageous for the public in that they will bring higher standards of
nursing service and a greater measure of protection against incom
petency of practical nurses, particularly those who are untrained and
self-designated. For practical nurses themselves, new developments
PRACTICAL NURSES
5
in the occupation should prove beneficial in wages, conditions of work,
and job satisfaction.
Position openings for practical nurses should continue to increase
for some time to come, not only because of an expanding population
and advancing standards in health service, but because of the antici
pated movement of an increasing number of professional registered
nurses into occupations which require college-level training in clinical
specializations, nursing education, and administration. Practical
nurses, more than ever before, will be needed to assist registered pro
fessional nurses who are employed in general duty work, in order
to meet the Nation’s need for bedside and direct patient care. In
fact, many general duty nursing jobs previously performed by pro
fessional nurses with the minimum of 3 years of hospital-school train
ing can be done, and are being carried out, by adequately trained and
properly supervised practical nurses, in accordance with the nursingteam idea.
Some specialists who have taken a long, hard look at the Nation’s
need for nurses and at the changes already achieved in many kinds of
nursing occupations to make the best use of nursepower, believe that
some jobs can be merged, and in time, will move together. This
means that in place of two classes of workers, the adequately pre
pared and highly proficient practical nurse and her professional col
league with minimum training, there may some time be only one:
general duty nurse, for whom a new set of vocational requirements,
somewhere between the two, is established. Other specialists con
cerned with the nursing function think that there will continue to
be a need for three broad classifications of nurses: The nurse prepared
in a collegiate program (with 4 years or more of education beyond
high school), the nurse prepared in a hospital school (in a program
about 3 years long), and the practical nurse with 1 to li/2 years of
training in a vocational or hospital school.
Studies of the nursing function have continued since World War II,
with great concentration of effort, among educational institutions,
hospitals, and professional nursing organizations. In 1953, there
was hardly a nurse on active duty in hospitals and health agencies
whose cooperation had not been enlisted, or whose interest, at least,
was not aroused by research groups studying the nursing function.
As a result, there should be available, in time, a considerable body of
new information which will provide the basis for establishing uni
form standards in education and training and in work performance
for all types of nursing jobs. Meanwhile, there is a sound vocational
basis and a good job future for women who wish to enter, or continue
in, the field of practical nursing.
6
OUTLOOK FOR WOMEN
EMPLOYMENT OUTLOOK FOR PRACTICAL NURSES
Beginning with World War II the demand for practical nurses has
considerably exceeded the supply, and all estimates of need indicate
that employment opportunities for practical nurses will continue to
expand, both in number and job variety, for some years. The greatest
need will be for practical nurses in hospitals and in private-duty
nursing in all sections of the Nation. Job standards and require
ments will continue to change, along with changes in nursing service in
general, affecting both nursing education and employment.
Difficult problems are met in all efforts to take accurate inventory of
the Nation’s supply of experienced practical nurses, and even more
complex problems are encountered when it comes to estimating the
need. Realistic answers to supply and demand problems depend
largely upon the accumulation of much more complete and accurate
information than has been available, or will be available, for several
years at least. Because nursing itself is in transition, better methods
of obtaining facts about any aspect of nursing service will probably
not, in themselves, provide answers to supply-and-demand questions;
furthermore, information is likely to be useful only at the time it
is obtained.
For these reasons, it is possible only in a very general way to indi
cate the trends in supply and demand of practical nurses and to dis
cuss the employment outlook.
How Many Practical Nurses in the Civilian Labor Force?
Postwar predictions, which pointed toward an increase in the num
ber of practical nurses, were undoubtedly justified. The supply of
practical nurses was increased by about 35 percent in the decade from
1940 to 1950, or in numbers, from 107,320 to 144,240.
Table 1.—Practical Nurses
and
Auxiliary Workers (Experienced): 1940
AND 1950
1950
1940
Occupation
Total
Practical nurses and midwives
Practical nurses
Midwives _
Attendants, hospital and other
institutions
Women
146, 034
144, 240
1, 794
139, 793
138, 292
1, 501
2 107, 320
2 1, 967
104, 338
102, 460
1, 878
210, 756
124, 733
102, 189
44, 702
Total
109, 287
Women
1 Figures for 1950 are for experienced civilian labor force (including employed and experienced unem
ployed who are seeking work); these data are not exactly comparable with data for earlier decades.
2 Women’s Bureau estimates.
Source: U. S. Department of Commerce, Bureau of the Census, 1950 Census of Population: and U. S.
Department of Labor, Women’s Bureau, Women’s Occupations Through Seven Decades, pp. 148,162, 222, 238.
PRACTICAL NURSES
7
About 95 percent of these persons were women, numbering 102,460
in 1940 and 138,292 in 1950. Furthermore, preliminary checks on
these census figures indicate that the data for practical nurses prob
ably understate the number actually in the labor force. Because
of the absence of a clear-cut, commonly recognized definition for prac
tical nurse, it is recognized that a number of practical nurses were
inadvertently included in the professional nurse group—as a result
of comparison between trained and/or licensed practical nurse and
professional nurse. Confusion also exists in distinguishing between
practical nurses and attendants in hospitals.
Women hospital attendants numbered 124,733, according to the 1950
decennial census; and there is some basis for regarding a part of the
hospital-attendant group as equivalent to practical nurses. For a
number of years preceding World War II, hospital attendants and
practical nurses shifted job settings: hospital attendants who went
into private duty classified themselves as practical nurses, and the
reverse also took place. During and after the war, there was a general
shift from private household jobs to hospital jobs on the part of many
practical nurses, and it is likely that a number of experienced practi
cal nurses were enumerated in the 1950 census as hospital attendants.
Because of the absence of information about the job duties and ex
perience of practical nurses and attendants in hospitals, and fbout. the
duties of auxiliary nursing personnel such as nursing aides, no reliable
conclusions about the actual count of practical nurses can be reached.
Except for the group of practical nurses which could probably be
singled out as licensed on the basis of certain standard requirements
of training and experience (such as graduation from approved prac
tical nurse programs and passing of a State board examination), es
timates of supply tend to be misleading. Among the group of prac
tical nurses who were licensed by waiver of examination when States
began to set up licensing requirements (see p. 18 on licensing), there
may be those who are not any better qualified than nursing workers
of other occupational classifications, such as attendants and nursing
aides, wdio may have received on-the-job hospital or clinical training of
relatively high standard. In time, if licensing and job requirements
become increasingly more standardized for all classes of nursing work
ers, it will be possible to estimate supply of the various kinds of nurs
ing personnel with greater confidence.
Where Practical Nurses Work
It was estimated by the American Medical Association in 1950 that
49,880 practical nurses, women and men, were employed in hospitals
(6). This represents roughly about one-third of the 1950 census count,
and it is generally assumed that all practical nurses are distributed as
follows: One-third in hospitals, one-third in nursing homes and other
health institutions, and one-third in private household employment.
8
OUTLOOK FOR WOMEN
• s*
ginma
'***'" ,
Figure 2. In the hospital, practical nurses can carry a large share of
bedside nursing care.
PRACTICAL NURSES
9
A much greater proportion of graduates of practical nurse programs
than one-third go into hospital employment. In 1951, over 65 percent
of graduates of public-school programs entered hospital employment,
and in 1952, as many as 71.6 percent. Private-duty nursing benefited
by less than 5 percent of public-school graduates of practical nursing
in 1952. (See table 2.)
A study made by the College of Nursing of Wayne University re
ported the last employment in 1949 of 392 of the 428 graduates of the
Michigan practical-nurse training program {32). Eighty-three per
cent of these graduates were employed in hospitals, 10 percent were
doing private-duty nursing in homes or hospitals, 3 percent were work
ing in convalescent homes, and 4 percent were employed in doctors’
offices and public health agencies or acting as children’s nurses.
An analysis of the type of employment of 1,633 practical nurses,
reported in a survey made by Practical Nurses of New York, Inc.,
in 1949 showed that 44 percent were employed in hospitals, 31 percent
in private-duty nursing, 12 percent in institutions other than hospitals,
Table 2.—Placement
of
Practical Nurse Graduates
Programs, Fiscal Years 1
1952
and
1952
of
Public School
1951.
1951
Placement
Number
Total
_____
Employed in practical nursing. __
All hospitals . . _
General
_
Tuberculosis
_
Mental
Chronic
_
Children’s
_ ._
Convalescent
Other .
Private duty__
_ _
Doctor's office
...
Industry (nursing) _ .
Public health..
Not emplovedin practical nursing _
Nonnursing occupation .
Home housework
.
Entered professional nursing _
Status unknown. _
Percent
Number
Percent
3, 565
100. 0
3, 424
100. 0
2, 664
2, 551
2, 167
70
13
41
34
108
118
168
79
5
29
249
39
175
35
484
79.
71.
60.
2.
.
1.
1.
3.
3.
4.
2.
.
.
7.
1.
4.
1.
13.
2, 568
2, 233
1, 786
56
36
35
48
94
178
193
94
75.
65.
52.
1.
1.
1.
1.
2.
5.
5.
2.
.
1.
6.
1.
4.
.
18.
4
6
8
0
4
1
0
0
3
7
2
1
8
0
1
9
0
6
12
36
235
41
162
32
621
0
2
2
6
1
0
4
7
2
6
7
4
1
9
2
8
9
1
1 July 1-Tune 30.
Source: Trade and Industrial Education Branch, Office of Education, Department of Health, Education
and Welfare.
259707°—58------3
10
OUTLOOK FOR WOMEN
4 percent in convalescent or nursing homes, 1 percent in physicians’ of
fices, 1 percent as industrial nurses, and the remainder in other nursing
or nonnursing employment.
Placement-agency reports are not reliable guides to occupational
distribution because they generally provide information in terms of
placements, rather than workers, and specific agencies are likely to
do business with special classes of applicants. For example, the fact
that 62 percent of all practical-nurse placements made by 79 nurse
registries in 1951 were for private-home duty (#) is not an indication
of employer distribution because mainly those practical nurses who
seek private duty use the nurse registries. Furthermore, the applicant
group was undoubtedly considerably less in number than the 37,000
placements reported for 1951; most private-duty jobs are of short du
ration, and the registry places the same applicant in a number of
different positions during the year.
From all information available in 1953 it can be concluded that the
employment trend among recently trained practical nurses is toward
hospital jobs, that 75 percent or more have obtained hospital employ
ment after graduation from training courses in recent years, and that
at least one-third of experienced, but not formally trained, practical
nurses tend to seek private-duty employment.
The distribution of practical nurses among industrial establish
ments, doctors’ offices, and other places of employment is relatively
small compared to the two broad assignments of practical nurses to
hospital and private-duty work. Public health agencies probably
represent the next largest group of practical nurse employers.
The Demand for Practical Nurses
For both civilian and military hospital service employment, there
has been a great demand for practical nurses since the war. The mili
tary services have mainly used men in the capacity of auxiliary
nursing workers to assist professional nurses, but the number of
women in positions equivalent to practical nursing has increased
slightly, and would probably continue to increase if there were enough
enlisted women to qualify for the job.
The demand for practical nurses in civilian employment has been
felt mainly in hospitals; and among all types, mental hospitals claim
the most critical shortage. At the same time, many nursing and medi
cal authorities have expressed the point of view that there is an
unprecedented need for practical nurses to work in private household
nursing, especially for subacutely or chronically ill and invalid pa
tients where clinical skills and training are not required to the same
extent, or quality, as in hospital nursing care.
PRACTICAL NURSES
(a) Starting out on the day’s round
of home visits for a public health
nursing agency.
11
. Mtela fei««
tllk
';
(b) Demonstrating the right
way to handle baby in
bath.
(c) Giving insulin
to an aged dia
betic patient.
Figure 3. Practical nurses visit homes to give nursing care and
instruction in home nursing methods.
12
OUTLOOK FOR WOMEN
In disagreement with this position are those who point out that the
center of nursing care is no longer in the home, and that for such sub
acutely ill patients as are nursed at home, there can be other methods
and programs to provide appropriate nursing care, such as the edu
cation of families in home nursing, and a wide extension of public
health and visiting-nurse services to both rural and urban areas.
Nursing experts believe that provision should also be made for short
term training programs to prepare women to perform housekeeping
duties and some of the elementary auxiliary nursing care in private
homes. A visiting housekeeper service by which substantial and highstandard assistance could be made available to families requiring help
during illness would be less costly than the use of trained practical
nurses in private-duty employment.
A critical shortage of professional registered nurses in hospitals
and health agencies in relation to increasingly complex clinical re
quirements has focused attention on the importance of using prac
tical nurses, together with other auxiliary nursing workers. Esti
mates of demand for practical nurses have been related closely to esti
mates for professional nurses, because of the interdependence of both
groups. The desirable ratio of one to the other, however, has not
been determined, and may never be determined except in a general
way. It depends extensively upon the divisions of function, or the
kinds of job duties that can be assigned to professional nurses and
auxiliary nursing workers in all team relationships, and considerable
research must be done along these lines.
In December 1952, the President’s Commission on the Health Needs
of the Nation estimated roughly that the shortage of professional
nurses for the country as a whole in 1960 may exceed 50,000, and
that regional shortages are more critical in the South and Southeast
than in the New England States, the Central Atlantic States, and the
Far West. Concerning practical nurses the report stated:
The number needed remains to be determined. However, the supply is
so far below the present need that it is apparent that recruitment for
approved schools of practical nursing should be greatly accelerated. (21)
In 1953 the Office of Education estimated that practical nurses were
being graduated from approved training programs at the rate of 6,000
a year, and recommended an annual increase in the supply of practical
nurse graduates to 15,000 annually, if the Nation’s needs are to be met.
A Brookings Institution study in projecting needs for America’s
health personnel stated that there were 29,099 job vacancies for practi
cal nurses in 1952, and that only 72 percent of practical nurse jobs
across the Nation were filled. The same study estimated a need for
41,833 additional practical nurses by 1957 (7). Unless the estimated
6,000-a-year rate of graduation of practical nurses from approved
PRACTICAL NURSES
13
training schools is increased, this would indicate a shortage of over
11,000 by 1957, of newly licensed practical nurses.
Because many nursing personnel research projects have led to the
conclusion that the Nation will not have an adequate number of pro
fessional registered nurses in the foreseeable future, in relation to
continuously expanding demand and the extension of medical care, all
projections of the required number of practical nurses and auxiliary
nursing workers remain open. In a 1948 report for the National Nurs
ing Council (10), Dr. Esther Lucile Brown stated, in answer to ques
tions raised about nurse unemployment in the event of a severe eco
nomic depression:
Even should there be a marked recession, demand for nursing care has
been raised to so much higher a plane that a very large supply [L e., pro
fessional nurses] would probably still be needed.
Dr. Brown expressed the opinion in the same report that in spite of all
nurse recruitment efforts of professional and civic organizations,
“there is little real hope that an adequate supply of graduate [pro
fessional] nurses can ever be obtained if demand remains insistent.”
Estimates of demand for all classes of nursing personnel, after hav
ing been projected to almost fantastic figures in relation to availability
by many agencies, following World War II, were being discussed in
much broader terms by 1953. Most authorities concerned with the
Nation’s health needs had begun to feel that it was no longer so im
portant to project estimates for nursepower as it was to try to discover,
through intensive study, what kind of nursepower was needed and
how the nursing function could be distributed among various kinds of
personnel with different degrees of preparation and training. Some of
the findings of studies and preliminary reports made up to 1953 and
their implications in terms of the outlook for auxiliary nursing work
ers are discussed in part II of this bulletin.
Outlook for Minorities, Older Women, and Married Women
Because of the critical shortage of nursing personnel, employment
restrictions which tend to limit women in many kinds of work had been
considerably relaxed for practical nurses by 1953.
The President’s Commission on the Health Needs of the Nation in
cluded a special recommendation for the encouragement of Negroes
in its report of December 1952 (21), as follows:
To meet, the need for additional Negroes in the health professions: [it isi
recommended] That special programs be formulated to make more and better
preprofessional and professional opportunities available for the education
and training of Negroes in the health professions. The dual system of edu
cation in some parts of this country has made it impossible for many Negroes
to receive the high-quality secondary and college education needed to qualify
them for professional training. The discriminatory bars which start at the
14
OUTLOOK FOR WOMEN
secondary-school level and run all the way through postgraduate training,
internship, and hospital affiliation must be removed wherever they exist.
Older women, instead of being barred, are encouraged to enter prac
tical nurse training. Employer specifications for practical nurses
usually leave the upper age open if job candidates are otherwise quali
fied. As far as nursing care is concerned generally, maturity is pre
ferred for practical nurses, and there tends to be an exercise of caution
with respect to the lower age limit, rather than the upper.
Marriage is no barrier for practical nurses in obtaining employment
if home responsibilities permit attention to job duties. The practical
nurse who is, or has been, married is often considered a more likely
candidate for the occupation than many older single women because of
the experience and information she may have acquired in household
management and home nursing care.
CONDITIONS OF EMPLOYMENT
Earnings of Practical Nurses
Periodic surveys made by the American Hospital Association pro
vide the most reliable source of information available on practicalnurse salaries in hospitals. According to the AHA survey for 1952,
the average gross beginning salary for practical nurses in 2,308 hos
pitals reporting (except Federal) was $164 monthly, or $1,968 an
nually (1). Compared with the earnings of other hospital personnel,
this was a little higher than for clerks, whose average gross beginning
salary was $160 monthly, and about 70 percent of the average gross
starting salary for professional nurses on general duty, which was
$233 monthly.
Variations in practical-nurse starting salaries in individual hos
pitals range from less than $100 monthly to over $200 monthly. Dif
ferences in pay can be related to such considerations as the type of
service which the hospital provides, the size of the hospital, and the
location.
Specialized hospitals in recent years, have paid higher salaries to
practical nurses than have general hospitals. In 1952, mental and
tuberculosis hospitals paid 20 percent higher starting wages than gen
eral hospitals—gross monthly averages of $190 and $189, respectively,
as against $159. The monthly gross average for other special hos
pitals was $164.
When salaries in 1952 were grouped according to hospital size, aver
age salaries for practical nurses increased with the size of the hospital
from $159 monthly for 51-to-100-bed hospitals, to $197 for hospitals
with more than 1,000 beds. However, there were 551 small hospitals
of 25 to 50 beds and 180 hospitals with fewer than 25 beds which
reported monthly average salaries between $161 and $163.
PRACTICAL NURSES
15
Tabulation of hospitals by geographic region showed that Pacific
coast hospitals paid the highest starting salaries, or a monthly average
of $180 for practical nurses in 1952. The East North Central region
was next highest, with $174 monthly for hospitals reporting, and the
New England States close behind with $171 monthly. Lowest monthly
salaries were paid in the West South Central and East South Central
regions, or $143 and $147, respectively. No Pacific coast hospital, and
very few New England hospitals paid an average monthly starting
salary of less than $130.
Hospitals in cities of less than 2,500 population and cities of more
than 1 million had the highest average of beginning salaries for prac
tical nurses in 1952—$171 and $176, respectively. In metropolitan
areas ranging in population from over 2,500 to 1,000,000, average
monthly salaries varied from $155 to $164, but the differences showed
no particular relationship to the size of the city.
State hospitals in 1951 and 1952 paid higher salaries to practical
nurses than hospitals under all other kinds of management, except
Federal. In 1952, the average monthly starting salary was $189 for 201
State hospitals reporting, as compared to $157 for 1,087 church op
erated hospitals surveyed.
The statewide average of gross monthly starting salaries for all
hospitals (excluding Federal hospitals) in 1952 was less than $150 in
the following 9 States: Alabama, Arkansas, Georgia, Kentucky,
Louisiana, Mississippi, North Carolina, Oklahoma, and Texas. Among
these, the lowest were Arkansas with $131 and Alabama, with $138 as
a gross average for all hospitals. In 5 other States the gross averages
were $150 to $152 monthly—Florida, Kansas, Pennsylvania, South
Carolina, and Tennessee. Highest average statewide starting salaries,
between $179 and $188 monthly, were reported for hospitals in the
following States: Arizona, California, Connecticut, Michigan, Ne
vada, Oregon, Washington, and Wyoming.
Comprehensive and reliable information about the earnings of prac
tical nurses who work for individual employers in private homes or
in physicians’ offices is not available. There seems to be no doubt,
however, from the scattered reports and observations at hand, that
practical-nurse salaries in private employment tend to vary a great
deal more with location and fluctuations in the economy, and in supply
and demand, than salaries in institutional employment.
A director of a professionally approved vocational training school
for practical nurses in the District of Columbia reported in 1952 that
graduates of that school expected to earn from $7 to $8 daily, with
1 meal and carfare, for duty in private homes, and $1 for each hour
under 8. Overtime work tended to pay somewhat less, with a $10
daily rate for 12 hours of duty. At these rates, trained practical
16
OUTLOOK FOR WOMEN
nurses on their first jobs, after completing training, expected to earn
about $50 weekly.
Another report by an occupational research organization in a mid
western city in 1950 cited wage rates for practical nurses in private
employment as ranging from $7 to $11 daily, without maintenance (23).
Hospitals themselves do not employ practical nurses for privateduty work, but arrangements may be made through nurse registries
by individual patients or their families for obtaining practical nurses
for private duty in hospitals. Occasionally, higher than prevailing
rates are paid in cases of acute need; at times of critical shortage
practical nurses are able to earn $12 or $15 daily for a 10-hour day.
Salaries in such cases are sometimes quoted as indicative of prevailing
rates and, as a result, erroneous public opinion is created about the
pay of practical nurses.
One illustration of the possibilities of local variation in salary is
cited in the case of San Diego in 1951. The California Department
of Employment reported minimum earnings for practical nurses in
June 1951, in San Diego, of $135 monthly, and average earnings of
$150 monthly. From the source of the report it may be assumed that
the rates were for jobs with different categories of employers, both
institutional and private household. San Diego was in an area (Pa
cific coast) that reported an average monthly beginning rate for prac
tical nurses in hospital jobs of $169 in 1951. According to the Women’s
Bureau field representative who obtained the report, San Diego in
1951 was an exception to California metropolitan areas in paying
relatively low wages for most categories of work, although it was
considered to be an area of labor shortage in defense-connected indus
tries. Apparently, local practices offset both critical shortage and
prevailing rates in the region.
In Federal civil service the trained practical nurse in 1952 received
a beginning salary of $2,950, grade GS-3, and the professional nurse
received a beginning salary of $3,410, grade GS-5.
Salary Trend
Salaries for all nurses are relatively low compared with industrial
and clerical employment for women, and in consideration of the prep
aration required. Increases in practical-nurse salaries are closely re
lated to increases for professional nurses, and earnings of practical
nurses tend to be about three-fourths of general-duty nurses’ earnings.
There is reason for some optimism about the possibility of a con
tinuing general increase, apart from cost-of-living increases, in the
salaries of all nursing workers, and practical nurses in particular.
Developments are taking place toward standardization of training and
job requirements, and there is great demand in hospitals and health
agencies for the practical nurse as a team member.
PRACTICAL NURSES
17
A glance backward at the American Hospital Association’s surveys
for the years 1945, 1951, and 1952 shows that greater variation in
salary for practical nurses than for professional nurses was found
among individual hospitals between 1945 and 1952. Both groups, of
course, show an increase in average salaries, a 50-percent increase in
1952 over 1945 for professional nurses on general duty and a 45-percent
increase for practical nurses in the same period.
There appeared to be a trend in 1952 toward increasing local vari
ations in practical-nurse salaries, regardless of whether hospitals
were grouped according to size of hospital, size of city, type of hos
pital service, or type of control. In 1945, for example, average
monthly starting salaries for practical nurses in 8 different categories
of hospitals, grouped by size, varied from lowest to highest by only $11$
(or from $109 to $122) ; by 1952, the variation was as much as $38 (or
from $159 to $197) for essentially the same group of hospitals. For
hospitals grouped according to type of service, there was a differential
of only $10 in 1945 in the range of salaries paid practical nurses (from
$111 to $121) ; by 1952 the lowest and highest ranges differed as much
as $31 (or from $159 to $190). Again, State hospitals led all others
(except Federal) in paying the highest average monthly salaries in
both 1945 and 1952, but the differential in salaries between hospitals,
according to type of control, was $6 in 1945 and $32 in 1952.
From these contrasts it can be seen that the hospital salary situa
tion for practical nurses was characterized by greater individual local
variations in 1952 than in 1945, although, in both survey years, prac
tical nurses were in short supply. This observation is further sup
ported by the fact that there was closer relationship, in 1945, between
the size of the hospital and the salary range: small hospitals, of fewer
than 25 beds, paid less than larger hospitals. Although the trend in
1952 showed an increase in salaries which was correspondingly higher
as hospitals increased in size from 101 beds upward, an exception was
noted for hospitals of fewer than 25 beds, which paid more than hos
pitals in three other groups. There is no doubt that increasing local
demands and a general shift in the occupational setting from private
to hospital employment have brought changes in salary patterns apart
from the overall increase in hospital wTages for practical nurses since
1945.
Hours
According to the American Nurses’ Association report from 79
nurse registries in 1951, about 53 percent of 22,883 practical-nurse
placements for private-home jobs were for an 8-hour day; 37 percent
were for positions of more than 8 hours a day; and 2 percent were for
jobs requiring less than an 8-hour day. Information was not avail259707°—53------4
18
OUTLOOK FOR WOMEN
able on the number of hours worked for about 8 percent of the place
ments. Findings were based on reports from registries in 28 States,
the District of Columbia, and Hawaii (0).
Wide variation in hour schedules is found in hospitals. An 8-hour
day is often the rule in the hospital, but nurses, practical and profes
sional, may be required to work on odd shifts, from 7 a. m. to 3:30
p. m., from 3: 30 p. m. to lip. in., or from 11 p. m. to 7 a. m. Practical
nurses in hospitals averaged 44 hours a week in 1952 (7).
According to an analysis by the Women’s Bureau of a 1949 survey
conducted by Practical Nurses of New York, Inc., the hours worked
per week, by 809 practical nurses reporting who were employed in in
stitutions, varied from under 40 to over 56. However, the 40-hour,
44-hour, and 48-hour weeks were the most common. Thirty-seven
percent of the practical nurses worked the 40-liour week, 19 percent
worked the 44-hour week, and 32 percent worked the 48-liour week.
The Joint Committee on Practical Nurses and Auxiliary Workers
in Nursing Services recommends that the hours of work for the prac
tical nurse should be the same as for the professional nurse, preferably
a 40-hour week (5). Rotation of hours, planned in advance, is rec
ommended with a fair division among practical nurses of the less
popular hours and services in hospital assignments.
Licensing
Licensing of practical nurses is important to provide assurance to
the public that the persons who are employed as practical nurses are
able to meet certain basic qualifications as set forth by the licensing
regulation of a State or Territory. At the same time, licensing pro
tects the interests of the qualified practical nurse who runs the risk of
competing for employment with self-designated practical nurses.
As of May 1953, 40 States and Puerto Rico and Hawaii had estab
lished licensing provisions for practical nurses or for persons who
were essentially practical nurses, although they may have used other
titles. Only 6 of the States had mandatory licensing regulations:
Arkansas, Idaho, Louisiana, Nevada, New York, and Rhode Island.
Because of the strong recommendations of national nursing organi
zations for licensing of both practical and professional nurses, most
agency or institutional employers in States where licensing is estab
lished will not employ an unlicensed practical nurse, and nurses them
selves appreciate the value of the regulation and obtain licenses whereever they are provided, although the requirement may not be
mandatory.
A practical nurse may obtain a license in one of several ways, the
most common of which are:
(1) By completing training at an approved school of practical
nursing and passing the State board licensing examination, or
PRACTICAL NURSES
19
(2) By endorsement of a State board if a practical nurse has ob
tained a license in another State with similar standards.
When a licensing law is enacted for the first time in any State, a
limited period of time is usually provided during which experienced
practical nurses may present evidence which will make them eligible
to qualify for licenses without passing examinations. A license issued
under these conditions is called a license by waiver, which means that
some part of the licensing requirements are waived, or dropped, for a
stated time. Educational requirements are most often waived during
this period, but some States may require a written examination in
addition to proof of satisfactory experience. Other States may waive
both education and the examination requirements. After the waiver
period has passed, new licenses are issued according to the conditions
set forth in the particular State law, and an examination is usually
required. There may be a partial waiver of licensing requirements
in some States after the waiver period has passed, in order to include
experienced practical nurses who can meet some of the licensing
requirements.
A practical nurse who is licensed in one State may move to another,
where a similar or equivalent licensing law is in effect. She may be
granted a new license, upon application, without having to take an
examination. The term used in this case is license by endorsement
(as stated above). If a license granted in one State is not acceptable
to the new State board, however, an examination may be required.
Because of the differences in licensing regulations among the States,
it is important for the practical nurse to become familiar with the
requirements of any State in which she wishes to practice.
Renewal regulations affecting practical nurse licenses vary from
State to State: Some require annual renewal; some provide for renewal
every 2 years and others do not require renewal at all.
Titles for practical nurses vary with the State licensing regulations.
The most common title, used in half the States, is Licensed Practical
Nurse, and this title is also recommended by professional and practical
nurse organizations. Other titles, some of which are misleading, are:
Licensed Attendant, Trained Attendant, Licensed Vocational Nurse,
Certified Practical Nurse, and Registered Practical Nurse (5).
The Trend in Licensing
Licensing of practical nurses is a relatively new movement among
the States, and 50 percent of all State licensing laws have been estab
lished in a period of 8 years, between 1945 and 1953. The very first
licensing regulation for nonprofessional nursing workers was for
“licensed attendant” in Mississippi, in 1914. Maryland was the next
State and began to license “practical nurses” in 1922, followed by
California, Florida, and Pennsylvania. Not more than 12 other
20
OUTLOOK FOR WOMEN
States enacted regulations for practical nurses until after World War
II. By 1945 only 19 States and Hawaii had licensing regulations for
practical nurses (3). In 1953, 40 States, Hawaii, and Puerto Rico
provided for practical nurse licensure.
Some indication of the licensing trend may be obtained by a review
of reports on the number of practical nurses who were licensed up
to 1945 and in the years following. A report by the American Nurses’
Association in their 1946 annual fact book (3) estimated that a total
of 31,510 practical nurses had been reported as licensed among 14
States in the period of 31 years from 1914 to 1945. (There were no
reports for 3 of 19 States surveyed, nor for Hawaii which enacted
licensing laws in the same year (1945), nor for Wisconsin, which had
passed a law in 1943.)
The majority of licenses reported were for New York, which alone
accounted for 20,856 of the total number of practical nurses licensed
by waiver, examination, or endorsement. Although complete and
reliable data on licensure were not available in 1945, there is good
reason to conclude that not many more than 11,000 or 12,000 practical
nurses had been licensed in all other States from the beginning of the
enactment of State laws. Only Arkansas and New York State had
mandatory regulations, and very little advantage had been taken,
either by practical nurses or their employers, of the permissive regu
lations in other States.
Although most of the practical nurse licensure regulations were
still of the permissive type by 1950, there were well over 11,000 new
practical-nurse licenses—issued for the first time in that single year—
reported by 29 States and Hawaii. In addition, a total of 53,406 re
newals were reported for 1950 in 24 States providing for license
renewal either annually or biennially (3).
Preliminary estimates for 1952 by the American Nurses’ Association
indicate that over 22,000 new practical-nurse licenses were issued in
37 States and 2 Territories, double the number of first licenses re
ported for 1950. Practical-nurse license renewals in 1952 were esti
mated at close to 77,000.
The number of practical nurses who obtained State licenses by
written examinations from 1950 to 1953 was very close to the annual
number of graduates of approved schools of practical nursing which
has been estimated roughly at 6,000 a year for 1952. In 1950, 5,006
practical nurses obtained licenses in the United States by written
examinations, or 44 percent of all the licenses issued. In 1951, al
though the number of licenses issued by examination increased to
6,387, it was still only 43 percent of the total; and in 1952, the propor
tion taking examinations was less than one-third, although the num
ber was 6,649. With the enactment of new State licensing laws in the
PRACTICAL NURSES
21
1950’s, a great many practical nurses who had been vocationally es
tablished for some time undoubtedly took advantage of the waiver of
examination in order to become licensed. This means that most of
those who are licensed are not graduates of practical-nurse vocationaltraining programs. It was estimated in 1950 that 85 percent of all
licensed practical nurses had no formal training (16 and 20).
There is good reason to anticipate that licensing of practical nurses
will soon become established in all 48 States; also that reforms will be
made gradually in practical-nurse licensure. Nursing organizations
are seeking the cooperation of the States in obtaining greater uni
formity in licensing practices, in the general raising of requirements
to meet the basic standards of approved practical nursing schools,
and in the enactment of mandatory, rather than permissive, regula
tions. In another decade it is likely that nearly all practical nurses
applying for first licenses will be graduates of approved training
programs, and that there will be a much greater degree of uniformity
in the basic requirements for training and proficiency for all States
and Territories.
Social Security
Practical nurses employed in private hospitals and institutions op
erated for profit have been covered by old-age and survivors insurance
since the Social Security Act was first passed in 1935. Beginning with
January 1951, amendments went into effect under which most practi
cal nurses (except student nurses) are covered or can become eligible
for coverage. Employees in Federal hospitals and institutions are
covered by OASI unless they were already under the Federal retire
ment system. Old-age and survivors insurance is available to em
ployees of State and local hospitals and institutions in States which
choose to accept it, unless they are already under a State retirement
system. Nonprofit organizations may elect to come under OASI if
two-thirds of their employees sign the application.
In addition to those employed in hospitals and institutions, two
broad groups of practical nurses became eligible for coverage begin
ning in January 1951: Those who are self-employed and have net
earnings of $400 or more a year; and those who may be classified as
domestic workers, if they are employed at least 24 days, and are paid
at least $50 cash, in any quarter of the calendar year by one employer.
Some practical nurses employed in private hospitals and institu
tions operated for profit, or in industry, may be eligible for unemploy
ment insurance if they work for establishments which participate in
the State unemployment insurance programs, but it is believed that
the number is exceedingly small.
22
OUTLOOK FOR WOMEN
TRAINING FOR PRACTICAL NURSING
Types of Schools
There are three broad types of approved schools which offer train
ing for practical nurses: Those operated by public-school systems,
usually as part of a State or local vocational-school or adult-education
program; privately operated schools affiliated with hospitals and
health agencies; schools operated by hospitals. There are some com
binations of these three kinds of schools, both as to control and source
of income. About 47 percent of 135 schools that reported to the
National League for Nursing in 1952 were under State control and
about 55 percent received income from a State, although many of
these were affiliated with the city, county, or another local agency
which operated the school. At least 39 percent of the 135 schools
depended upon tuition fees as a source of income (2). Public-school
programs in practical nursing are eligible for Federal support if
approved by State boards for vocational education.
Registered hospitals reported 334 clinical programs3 affiliated with
schools of practical nursing in 1951 in 44 States and the District of
Columbia; of these, 108 were in governmental hospitals and 226 in
nongovernmental hospitals (6).
An Office of Education survey as of September 1952 reports a total
of 278 individual programs of practical-nurse training, public and
private, in 45 States, the District of Columbia, Alaska, Hawaii, and
Puerto Rico (27). Only Maine, New Hampshire, and Wyoming had
no training programs for practical nurses in 1952. Of the total num
ber reported, 184 programs were operating under public-school sys
tems in 38 States, the District of Columbia, Alaska, and Hawaii.
In May 1950, the convention of the National League of Nursing
Education (now a section in the National League for Nursing)
adopted a set of principles on nurse education which included a rec
ommendation that schools for practical nursing should be part of an
adult education program and that public institutions should provide
for such training (18). The Office of Education supports this view
because of the advantages of public-school education in such matters
as development of standards of instruction and general availability
of training.
School Approving and Accrediting Agencies
Approval of schools of practical nursing is usually made by the
State board of nurse examiners in States which provide for licensing
of practical nurses, or the State board of vocational education, or both.
3 Reported in AMA Journal 1952 (Hospital Number) as “schools” of practical nursing,
but undoubtedly participation in school programs rather than complete programs was
meant.
PRACTICAL NURSES
23
(a) A class in anatomy
(b) Professional nurse
teaches method of
sterilizing
surgical
dressings.
mm*,
(c) In learning urinalysis, stu
dent checks chemical reaction
with the textbook.
mmm
Figure 4. Today s practical nurses go to school before they practice.
24
OUTLOOK FOR WOMEN
The National Association for Practical Nurse Education (NAPNE)
offers a national accrediting service for schools in States without pro
visions for training and licensing of practical nurses, or for any other
schools which request it. In the Federal Department of Health, Edu
cation, and Welfare, the Office of Education provides advisory services
to State boards of vocational education on standards for public schools
which conduct practical-nurse training programs, but States main
tain the approval or accrediting function.
According to the Office of Education, programs for 144 of the 184
operated in public-school systems as of September 1952 had been
approved, and 84 programs were approved of a total of 94 operated
by private organizations (27).
Length of Courses
At least 9 months of preparation in an approved school of practical
nursing is required to become a trained practical nurse, and a few
States require as much as 18 months; the most common period of
training is 1 year or 2,000 hours f5). As of May 1953 there were
probably no more than 4 or 5 approved programs of less than 1 year
in duration, and the general opinion was that all approved schools
would soon reach the 1-year minimum.
Course Content
Many schools use “Practical Nursing,” an analysis of the practical
nurse occupation, and “Practical Nursing Curriculum,” suggestions
for developing a program of study, published by the United States
Office of Education and prepared by a representative national ad
visory committee (28 and 20). These publications furnish a na
tional pattern for training the practical nurse. The suggested basic
nursing skill and related instruction include meeting the health
needs of apparently well individuals and families; meeting the nurs
ing needs of the mildly ill and of the convalescent patient, of the
patient with long-term illness or disabling condition; meeting the
nursing needs of the mother and infant; and meeting common
emergency needs of individuals and families. Suggested additional
units of instruction include basic homemaking skills and related in
struction dealing with body structure and function, and the life span.
During the preclinical training in the public vocational schools,
students receive instruction in nursing arts from professional nurses
and in dietetics and home management from qualified teachers. Prac
tice is given under realistic conditions. During the clinical experi
ence in the hospital the student learns to care for all types of
illnesses for which she will be responsible. This experience is sup
plemented by regularly organized classes in theory. Some schools
provide supervised nursing experience in private homes.
PRACTICAL NURSES
25
Training is divided into about one-third of the total time for class
room or foundation instruction, and two-thirds for supervised clini
cal experience in an approved hospital. As noted from the
accompanying chart, there are three broad methods used by schools
to divide the time spent in the classroom and in the hospital. One
plan provides for all of the foundation work to be taken by the stu
dent during the first 4 months; a second plan divides classroom in
struction into two periods during the first half year, and introduces
the student to clinical experience in the third and fourth months.
The third plan combines classroom work with hospital training, be
ginning with the second month and extending throughout the year,
with clinical experience increasing gradually in proportion to class
room instruction until the fifth month, when it begins to require the
greater part of students’ time.
TYPES OF PRACTICAL NURSE TRAINING PROGRAMS
Months
1
2
3
7/ School
4
5
tyty/'/'X
6
Hospital
7
8
9
10
11
12
Review—Vacation
Source: Office of Education, U. S. Department of Health, Education, and Welfare, Trade
and Industrial Education Branch, May 1953.
It is believed that the first type of program is the easiest for the
school to administer, but that it is not so helpful to the student as the
third plan which makes transition from classroom to hospital easier.
The third plan is the most complex to operate.
All approved programs require the practical-nurse student to ob
tain clinical experience in the four basic hospital services: Medical,
surgical, obstetric, and pediatric. Some schools may add any or all
259707°—53------ 5
26
OUTLOOK FOR WOMEN
of the following services: Tuberculosis nursing, psychiatric nursing,
and the care of homebound patients.
Special emphasis has been placed on giving practical nurses ex
perience in home nursing in recent years. Nursing and health lead
ers recommended at a conference called by National Association for
Practical Nurse Education and the New York Academy of Medicine
in February 1951 that a program of home nursing be tried out under
careful medical supervision in four or five schools of practical nurses.
The Household Nursing Association in Boston offers a 15-month
course in home nursing for practical nurses. In 1951 students
received 6 weeks of instruction in a practice house, where they lived
and worked under conditions closely approximating the private home.
They were sent to small general hospitals affiliated with the school
for 13 months to learn hospital nursing methods in the care of the
sick. A 2-week final course was given at the school. For 24 weeks
after completion of the course, staff nurses visited the practical nurses
on their cases at least once a week {13).
In 1949, Baylor University School of Nursing at Dallas, Tex., es
tablished a course equivalent to practical nursing which leads to a
certificate from the university school for the occupational title of
“technician nurse.”4 The program includes a 4-month preclinical
period, followed by 8 months of clinical training and (> months of
“internship” in a hospital affiliated with the university. Entrance
requirements in 1951 called for applicants 17 to 30 years of age, liighschool graduation, and the passing of entrance examinations. Women
over 30 were individually considered. Of the first two classes to be
graduated, 57 percent obtained employment as “technician nurse” in
doctors’ offices, 33 percent chose hospital employment, and 5 percent
entered professional-nurse training programs {22).
Inservice Training in the Armed Forces
It has been the practice of the Army and Navy to use a large num
ber of men and relatively few women as practical nurses. This is in
contrast to the practice with respect to professional nurses in military
service, all of whom have been women.
The Army and Navy each offers courses which include, or offer the
equivalent of, practical-nurse training courses to enlisted men and
women medical service personnel who qualify. Job classifications
and course titles vary according to the branch of service, and training
includes many procedures peculiar to military service.
The United States Department of the Army conducts an advanced
medical technician procedure course for enlisted men and women
medical technicians who have completed preparatory training under
*Not to be confused with the occupational title “nurse technician” which refers to a
professional nurse trained In medical laboratory methods and procedures.
PRACTICAL NURSES
27
Army supervision. The course provides, in part, what amounts to a
course in practical nursing and a number of additional medical tech
nician procedures. Students are trained to assist the professional
nurse in caring for the acutely ill and to attend convalescent, chron
ically ill, or subacute cases under supervision. Enlisted personnel
cannot take this course unless they are able to give at least 1 year of
Army service after training, which lasts for a period of 48 weeks. A
graduate of the Army’s advanced medical technician procedure school
is eligible to take State board examinations for licensed practical
nurse. Courses were given in 1953 at Walter Reed Hospital’s Forest
Glen section, at Letterman Army Hospital in San Francisco, and at
Fitzsimons Army Hospital in Denver (26).
the United States Navy Department trains enlisted personnel for
practical nursing as hospital corpsmen for both the Navy and Marine
Corps. Women who complete the course are called Wave hospital
corpsmen or female hospital corpsmen. Four basic hospital corps
schools are used to teach practical nursing theory for a period of 20
weeks; following completion of the academic work, student corpsmen
aie sent to one of 27 naval hospitals for 6 months of supervised clini
cal experience. Because of the fact that clinical experience is post
poned until the end of the theoretical training and the school facul
ties do not have an opportunity to follow through on the complete
program, it is believed that this type of program is not as helpful
to students as plans in which clinical practice is a regular part of the
curriculum. Nevertheless, hospital corpsmen are able to meet exami
nation requirements in theory for practical nursing in many States
after leaving Navy service.
I he United States Department of the Air Force does not provide
any specialized training equivalent to practical nursing for its medical
service corpsmen.
Army and Navy training is accepted as qualifying to meet the edu
cational requirements for the Federal civil service classification of
“Trained Practical Nurse.” (See appendix.)
Extension Courses
Extension courses are given for practical nurses who have obtained,
oi aie preparing to qualify for, licenses by waiver of examination;
also for those who may be employed as practical nurses and wish to
obtain additional training. Several practical-nurse associations have
promoted extension courses, which are usually given in the evening.
Local boards of education in many States have set up extension courses
foi practical nurses, either as part of a high-school extension program
oi a program for adult education, in both urban and rural areas.
In some States, a group of 10 or more practical nurses who have been
employed continuously for at least 2 years at the occupation, and who
28
OUTLOOK FOR WOMEN
otherwise meet admission requirements, may apply to a local board
of education to organize an extension class {30). Hospitals, health
agencies, and such organizations as the YWCA have also provided
evening courses in practical nursing subjects in a number of
communities.
Combined Academic Training and Practical Nursing
Colleges and junior colleges which have approved practical nurse
programs of 1 year usually offer an additional academic education for
the practical nurse who is interested in extending her education. In
many of these colleges it is possible for a student to complete 2 years
of training which will lead to the A. A. (Associate of Arts) degree,
as well as prepare her for the State board licensing examination in
practical nursing. The list of schools in appendix 2 includes some
colleges and junior colleges offering this educational plan. Most of
them are located on the west coast, especially in California and Wash
ington, but a number of other States are represented.
Costs of Training
In the public-school systems, the cost of training ranges from no
fee to fees of $100 or more; in some schools in the Far West, the fee
was $180 in 1953.
If a student needs to earn her room and board, public-school
authorities will approve part-time employment that does not affect
her health or limit her educational opportunity. During the hos
pital training period it is sometimes possible for the student to obtain
an allowance for maintenance; some hospitals provide room, board,
and laundry instead of the allowance.
Most private, nonprofit vocational schools for practical nurses
charge a tuition fee. Because this fee varies considerably from place
to place, the student who is interested in a particular school should
make inquiries about tuition and other admission fees.
The Minnesota Legislature in 1951 approved a plan for providing
scholarships for practical (as well as professional) nurses who are
residents of Minnesota and could meet the qualifications of “need
and ability” (17). The scholarships are awarded only to students
in schools that provide for some experience in a rural or State hos
pital for the mentally ill. The amount of the scholarship for a prac
tical nurse is $300.
Financial aid seems to be needed by students mostly during that
part of the school program which is taken outside of the hospital,
because of the customary provision by the hospital of some type of
maintenance during the period of clinical training. Civic groups
such as Altrusa, Botary Clubs, local Bed Cross organizations, and
women’s auxiliaries in hospitals sometimes make scholarships avail-
PRACTICAL NURSES
29
able to qualified applicants for schools of practical nursing, usually
out of a general scholarship fund. Alumni associations of schools
of practical nursing sometimes raise money for scholarships. One
alumni association provides a scholarship for one graduate each year
from each of the high schools in the city.
In March of 1953, Congresswoman Frances P. Bolton introduced
into the 83d Congress a bill (H. R. 3850) to provide for nursing
scholarships and Federal grants for schools of nursing. The bill
provided that practical-nurse education be further supplemented, as
part of the Vocational Education Act of 1946, under which States
have been eligible for Federal assistance to establish practical-nurse
training through State boards of vocational education. In addition,
the bill proposed that students who qualify for practical-nurse train
ing in approved schools be given financial assistance for their edu
cation to the extent of their need, including tuition, maintenance, and
other costs of training not assumed by the school, such as books and
uniforms; also, for practical nurses taking hospital training outside
the community where the school is located, a provision for paying
travel expenses of needy students was included. Whether this or
a similar bill is passed, and when, depends upon public recognition
of the extraordinary need in the decade of the 1950’s to encourage
women to enter nursing.
The Outlook for Training
A very significant indication of the intense public interest in prac
tical-nurse training was the increase in the number of training facili
ties for practical nurses in the years following World War II. The
first full-time school for practical-nurse training was developed under
private sponsorship at Brattleboro, Vt., in 1918. Since 1918, the
Household Nursing Association School of Attendant Nursing (the
Massachusetts designation for a practical nursing school) in Boston
has been training persons to give nursing care in private homes. In
1919 a public-school practical-nursing program, the first of its kind,
was established at Minneapolis, Minn. By 1942, some additional pri
vate schools had been established, and there were only 8 public-school
programs in 8 cities and 4 States (16). By 1948, there were 47 pro
grams in 44 cities and 16 States, and as of June 1953, 210 practicalnurse programs were operating under the public-school systems in 183
cities, in 39 States, Alaska, Hawaii, and the District of Columbia. The
National League for Nursing reported that there were 240 approved
schools of practical nursing in 1952 (£), and the Office of Education
reported on the existence of 278 public and private schools in 1953.
Most of the 278 were approved and the others were awaiting approval
pending review.
30
OUTLOOK FOR WOMEN
It is possible that the present number of practical-nurse training
schools could prepare almost twice the present number of students,
estimated at 6,000 annually, if used to maximum capacity. It is rec
ommended policy, however, to keep the classes for each instructor
between 10 and 25 students, to help insure effective teaching (30).
Many cities and several States are still without practical-nurse train
ing programs, but schools were available for low-cost training to stu
dents in most areas of the country in 1953, and all signs in the field
of practical-nurse education were pointing toward a general increase
in the availability of training opportunities for the following years.
There is evidence of local public interest in providing advanced
training opportunities for practical nurses. All hospitals with the
proper facilities and a point of view about effective use of staff estab
lish basic inservice programs for their entire nursing personnel; some
have experimented with training practical nurses in the specialized
clinical fields, such as psychiatric nursing.
Some thought has been given to allowing credit for practical-nurse
training toward professional-nurse training. Discussions for and
against such a plan have taken place among nursing service and edu
cational agencies, but they usually conclude with additional questions
about some of the basic pending problems concerning divisions of the
nursing function and the future for various types of nursing person
nel. By 1952 the National League for Nursing had canvassed 970
schools of nursing to obtain their views about counting practical-nurse
education credits toward the basic professional-nurse course, and the
subject was scheduled for further intensive study in 1953.
In 1948, Dr. Esther Lucile Brown, in her report for the National
Nursing Council (10), presented the problem of professional- and
practical-nurse training as follows:
We come now to the question which is the most difficult of all to discuss.
It is the question of whether a graduate bedside nurse similar to many
general- and private-duty nurses of the present would be needed, if success
ful preparation of practical nurses on the one hand, and of truly professional
nurses on the other, should be achieved. Recent years have seen consid
erable clarification of those functions for which training of from a month
to a year may be sufficient, and equally of those functions which can be
efficiently performed only by persons with professional education. The
unsolved problem is whether personnel to give nursing care of an inter
mediate kind will be necessary.
Race, Marital Status, and Age in Relation to Training
Limitations upon students in the way of race restrictions, marriage,
and age were showing evidence of relaxation by 1952. Public-school
programs, except for those in sections of the country which still prac
tice segregation, generally provided equally for admission of Negroes
and white students to the same schools, and a number of States that
practice segregation had established approved schools for Negroes.
(See appendix.)
PRACTICAL NURSES
31
As to marriage restrictions, only 11 of 133 approved schools of prac
tical nursing reporting in a National League for Nursing survey in
1952 required their students to withdraw after marriage (2). Most
schools of practical nursing are not concerned about the marriage or
dependency status of students if these conditions do not interfere with
school attendance or student health.
All of the public-school systems which provide for practical-nursing
programs as part of adult education admit older women up to 50
years of age, if they can qualify in school aptitude and physical re
quirements. There is a general willingness among all schools, public
and private, to accept mature women for training, and the question
of upper age limit was left open in many schools throughout the Na
tion if individual admissions committees found candidates qualified
on the basis of health, aptitude, and general suitability. The mini
mum age for public-school admission of practical nurses was 18 (30),
and a 1952 study of the Office of Education indicated that the median
age of practical nurses in training was 32.
A FEW CAREER SUGGESTIONS
To Be or Not To Be—A Practical Nurse
Schools of practical nursing and nursing organizations can give
information about the advantages and disadvantages of becoming a
practical nurse in relation to an individual woman’s qualifications
and interests. Young women still in high school may ask the advice
of their counselors and teachers or find a helpful interviewer at a
local State employment service agency. Considerations about the
practical-nurse career will differ for women of different ages in mat
ters such as health, personality, and aptitude for certain kinds of study.
Personal qualifications for practical nursing are set forth briefly
as follows (31) :
(1) Good physical and mental health; ability to withstand stren
uous physical activity.
(2) Manual dexterity—or enough manual skill to handle instru
ments and equipment properly.
(3) Ability to work with, and to become interested in, a great
variety of people of different ages, personalities, and back
grounds.
(4) Ability to work under close supervision and to follow instruc
tions, verbal and written.
(5) Good judgment and tact in meeting situations and in dealing
with people.
32
OUTLOOK FOR WOMEN
* **■
Figure 5. Practical nurse students learn clinical specialties in hospital
practice.
(a) In pediatrics course, students practice in children’s ward.
(b) Registered nurse instructor teaches taking pulse and temperature in
nursing arts course.
Selecting the School
It is important for the practical-nurse candidate to obtain her voca
tional preparation in an approved school. (See p. 49 of this bulletin.)
The easiest way to obtain information about a school of practical
nursing is from the State Board of Nursing Education and Nurse
Registration, which is usually located in the State capital. Another
PRACTICAL NURSES
33
source is the National Association for Practical Nurse Education at
654 Madison Avenue, New York 21, N. Y. (30).
Usual requirements for admission to a practical-nurse training pro
gram are summarized by the Office of Education (U. S. Department
of Health, Education, and Welfare) as follows: Applicants must be
between the ages of 18 and 50; graduates of elementary school if
over 25 or have 2 years of high school if under 25; have good health,
show suitability for the practical-nurse career. Suitability for train
ing is determined by the school on the basis of interviews, personal
references, and aptitude tests.
Finding the Job
The wide choice of jobs open to the practical nurse presents a special
problem of finding the right job. Obviously, the basic considerations
are salary, possibility of advancement, working conditions, and such
matters of personal concern as location of the job and hours of work.
But these are not the only matters to consider, particularly for the
woman who is starting out on her practical-nurse career immediately
after completing her training. If there are no differences, or only
slight differences, in economic advantages of one job over the other,
the practical nurse will do well to choose employment that can add
to her skill and knowledge. She may wish to specialize in a field
such as psychiatric nursing care (for the mentally ill); or in pediatrics
(the care of children). Or she may look toward service in the public
health field as a home visiting nurse or in a general hospital. In
any case, she may choose a job on the basis of the additional experi
ence that she can acquire under good nursing supervision. There are
many people to help her find the right job, and without cost to her.
Agencies where the practical nurse may obtain information and
guidance about the kinds of jobs available in specific areas are: Ap
proved schools of practical nursing; State nurses’ associations, espepecially those for practical nurses; and State employment service
agencies that provide special counseling, such as the Nurse and Med
ical Placement Center of the New York State Employment Service,
affiliated with the United States Employment Service of the Depart
ment of Labor.
Because of the very critical need for trained nursing personnel in
the treatment of mental patients, practical nurses, as well as profes
sional nurses, will find many opportunities in the psychiatric nursing
field. Massachusetts provides special preparatory training for prac
tical nurses at the State mental hospitals. Other State and Federal
hospitals have established on-the-job training programs or specialized
psychiatric training for graduate practical nurses from time to time.
Nurse registries usually charge the applicant a fee for placement,
34
outlook:
for
women
but they are probably among the best, sources for employment in pri
vate households. There are two kinds of nurse registries: Those
which are affiliated with professional nursing organizations and used
extensively by hospitals, physicians, and public and private health
agencies; and private commercial registries which have varying stand
ards of practice. Some commercial registries will not place practical
nurses unless they are graduates of approved schools, meet certain
minimum qualifications, and have references from physicians and
patients. Fees charged by private registries with professional nursing
affiliations are usually made on an operating-cost basis, or if a little
higher, the charges made for service go toward support of the or
ganization. In some areas of critical nurse shortage, private employers
have paid the placement fee to a nurse registry.
Trade-marks
Part of the practical nurse’s equipment consists, first of all, of some
written document which identifies her as a qualified practical nurse.
This may be a State license or an identification card provided by a
reliable placement agency, or a diploma or certificate from an approved
school of nursing.
There are recommended uniforms for practical-nurse students which
are used by many schools and are becoming standardized: a washable
cotton dress with an emblem on the left sleeve, “Practical Nurse
Student.”
The uniform officially endorsed by the National Federation of
Licensed Practical Nurses for graduate practical nurses is all white,
with white cap, shoes, stockings, and with a sleeve chevron which is
a symbol or trade-mark of the practical nurse. Some State practicalnurse associations have adopted a cap insignia, in addition, of “PN”
(practical nurse) or “LPN” (licensed practical nurse). Employers
such as public health agencies and institutions may also require special
insignia for sleeve or cap, and their own distinctive uniforms for
visiting nurses. Some schools have adopted pins which may be worn
by the graduate practical nurse on her cap or uniform {19 and 30).
Joining a Practical-Nurse Organization
Practical nurses are encouraged to join an organization which will
help them to improve their career knowledge and increase their oppor
tunities for developing high standards of nursing service.
Three national organizations offer membership to graduate prac
tical nurses: the National Federation of Licensed Practical Nurses,
Inc. (NFLPN), founded in 1949; the National Association for Prac
tical Nurse Education, Inc. (NAPNE), established in 1940; and the
National League for Nursing (NLN), which admitted practical
PRACTICAL NURSES
35
nurses to membership in 1953. All have headquarters in New York
City.
The National Association for Practical Nurse Education was
founded mainly to promote sound practical-nurse education. Some
of the activities which NAPNE conducts for this purpose include:
an accrediting service for schools of practical nursing; consultation to
schools on the development of program and standards; research on
practical nursing education; provision of a clearinghouse for informa
tion on practical nursing in the United States and other countries;
publication of information about practical-nurse education; promo
tion of summer school courses or “workshops” for directors and in
structors of practical nursing schools, as well as workshops for
practical nurses. Poth individual and group membership is offered
by NAI NE. Individual practical-nurse membership includes gradu
ates of approved schools, licensed practical nurses, and practical nurses
who are members of their State practical-nurse association. Practicalnuise group members include organizations, such as alumni associa
tions of approved schools of practical nursing and State practicalnurse associations.
As of May 1953, NAPNE reported about 1,000 individual members
and 100 group members.
Under the 1952 amendments to the bylaws of the National Federa
tion of Licensed Practical Nurses, member State associations of licensed
practical nurses (or associations with equivalent title) pay per capita
dues for each and every member to the NFLPN, which provides for
automatic membership. Provision was also made at that time for
participation in NFLPN of representatives of State organizations of
unlicensed practical nurses, on the group basis, until such time as
licensure provisions are enacted in those States for practical nurses.
NFLPN was organized for the purpose of assisting practical nurses
to promote and maintain high nursing standards, to interpret the role,
and advance the career of the practical nurse, and to protect her occu
pational and economic interests.
In 1953 the NFLPN reported approximately 10,000 members with
chapters in 24 States.
I lie National League for Nursing is interested in nursing standards
and nursing education for both professional and practical nurses.
Although practical nurses were not eligible for membership prior to
19.)3, several NLN committees, especially one on Practical Nursing
and Auxiliary Nursing Service, have been active in research on pract ical nurse education and functions for a number of years. Their
studies include questions concerning the appropriate divisions of
service between practical and professional nurses.
36
OUTLOOK FOR WOMEN
In addition to the three national organizations reported, there are a
number of local practical-nurse organizations which do not have
national affiliation. A directory of organizations in Nursing World
of January 1953 reported on the existence of practical-nurse member
ship groups in 45 States, Hawaii, Puerto Rico, and the District of
Columbia. The only States in which there were no organizations
were Maine, Mississippi, and Wyoming (11).
PART II—AUXILIARY WORKERS
ON THE NURSING TEAM
Who Are the Auxiliary Workers?
Auxiliary workers in nursing service are sometimes divided into two
broad occupational groups: (a) Those whose work is related both to
the care of the patient and the patient’s environment, and who share to
a limited extent some of the routine nursing care for which the profes
sional and practical nurse have a much greater responsibility; (b)
workers who perform in hospital or institution job duties related
mainly to the care of the patient’s environment, such as cleaning,
housekeeping, messenger service, reception work, and clerical duties
(A) • Employees in the second group may become important members
of hospital or health agency nursing teams, but their job duties are not
necessarily related to nursing care, for there are many kinds of em
ployment besides nursing service in which most of them may be found.
It is often difficult to distinguish between the two groups because of
overlapping duties and interchangeability of job titles. Division into
two groups can therefore be only a rough guide to understanding the
job duties of the many different kinds of workers who carry out neces
sary and important assignments in nursing service.
Workers in the first group are known in hospital or institution work
largely as nursing aides (or nurse aides), ward attendants, ward maids,
ward and nurse helpers. Men workers in this group are called order
lies. In private households, assistants to the practical or professional
nurse, or to the family requiring help in home nursing care, may be
mother’s helpers or visiting housekeepers.
The second group of workers are found in hospital, institution, or
health agency work and not in private household employment. They
are classified occupationally into clerical and service groups. Clerical
workers include receptionists, desk clerks, messengers, errand girls and
boys. Service workers are cleaners, porters, diet maids, and kitchen
maids.
All of the auxiliary nursing workers (except practical nurses)
who assist professional nurses on the hospital or home nursing team
have one thing in common: they are not usually required to have
training or experience before employment. Hospital and private em
ployers hire persons in this group on the basis of certain physical quali
fications, personal characteristics, and aptitudes for auxiliary nursing
37
38
OUTLOOK FOR WOMEN
(a) Cleaning hospital bed.
(b) Caring for linen room.
(c) Preparing diets in the central
kitchen.
Figure 6. Auxiliary workers do hundreds of important service jobs in
the hospital.
AUXILIARY NURSING WORKERS
39
jobs, and provide on-the-job training, even for those who may have
had some experience. In hospitals, institutions, and health agencies,
on-the-job training may be planned and carried out according to cer
tain standards; often it is informal, and auxiliary nursing workers
receive day-to-day instruction from the immediate supervisor.
The American Hospital Association, for purposes of salary survey,
divides hospital nursing workers into professional nurses, practical
nurses, untrained men and women, and clerks. The “untrained”
group includes all of the workers in both groups except clerks (1).
“Hospital attendant” is a title that may represent a great variety
of workers, and include some practical nurses. (See pt. I, Employ
ment Outlook.) It should be noted that the 1950 census figure of
210,756 attendants in hospitals and other institutions (see table 1,
pt. I) included the following job classifications:
Assistant
Assistant, dispensary
Attendant
Charge attendant
Dispensary attendant
First-aid attendant
Floor girl
Helper
Helper, veterinarian’s
Physiotherapy aide
Therapy attendant
Helper, ward
Hospital aide
Nurse’s aide
Orderly
Tray girl
Utility man
Veterinary attendant
Ward attendant
In a survey of America’s health resources by the President’s
Commission on the Health Needs of the Nation, auxiliary nursing
workers were identified as practical nurses and attendants (in a
single group), nursing aides, orderlies, and ward maids {21).
Nursing Aide as an Entry Job in Hospitals
Of all the auxiliary nursing workers, the nursing aide (or nurse
aide) was singled out for special attention as an occupational clas
sification in 1950 by the Joint Committee on Practical Nurses and
Auxiliary Nursing Workers, and by many hospitals. Through in
tensive and well-planned training programs, a number of hospi
tals have prepared untrained women on the job to become valuable
members of the nursing team as nursing aides.
To identify the auxiliary nursing worker who provides nursing
care and service closest to that of the nurse, professional and prac
tical, the duties of the nursing aide as described by the joint com
mittee are summarized below (,)).
Typical functions closely associated with nursing care which nursing aides
may perform under supervision for carefully selected patients
(a) Physical assistance to patient or nurse.—Holding patient for treat
ments and care; assisting with placing of patient on and off wheelchairs,
stretchers, beds; dressing and undressing patient; assistance with bedpan
and with tubs, showers, body washing, and shampoos; assistance with feed
ing; watching patients who cannot be left alone; assistance to nurse with
post-mortem care.
40
OUTLOOK FOR WOMEN
(6) Escort and messenger service.—Accompanying walking or transported
patient to various hospital stations, and to and from admitting office; answer
ing patient’s calls; delivering messages and equipment.
Typical duties not directly connected with personal care of the patient which
may he assigned to this group of workers
Care and disposal of flowers, magazines, newspapers, waste and the like;
care of rubber goods, filling ice caps and collars and delivering to nurse, in
flating rubber rings; changing covers on stretchers, examining tables, screens,
etc.; cleaning and setting up patient unit, cleaning up at bedside after treat
ments or accidents; cleaning bath basins and utility room furnishings; collect
ing charts, records, reports as directed; delivering specimens; distributing
and collecting diet trays, drinking water; folding and stacking linen and
blankets, making supplies, caring for special equipment, gloves, instruments,
etc., after use; making unoccupied beds and cribs; receiving and escorting visi
tors; replenishing supplies in lavatories and utility rooms and keeping equip
ment in order; care of nourishment dishes if no maid service is available.
The Labor Department’s publication of job descriptions for hospi
tals (31) has defined nurse aide as a worker who “assists professional
nursing staff by performing routine duties in caring for hospitalized
patients.” Educational requirements are listed as follows; “A mini
mum of grammar-school education is essential and high-school edu
cation or equivalent is preferred.” Experience for the nurse aide is
stated as “preferable but not essential.”
It has been recommended generally that the nursing aide be super
vised directly by a professional nurse, or by a physical therapist or
dietitian if she is assigned to duties not directly related to nursing.
For women who are interested in hospital nursing service but who
do not take any preparatory training, such as the course in practical
nursing, the nursing-aide job offers a good employment opportunity.
Many nursing aides become interested in practical- or professionalnurse education as a result of the nursing-aide experience, which not
only gives them a valuable foundation for further nurse training but
contributes an important and much-needed service.
Increase in Nursing Aides in Hospitals
Between 1945 and 1951 hospitals benefited by a general increase
in the number of auxiliary nursing workers including practical nurses
and attendants, from 216,399 to 297,466. Of this group, nursing aides
alone increased from 49,774 in 1945 to 76,091 in 1951,5 or about 53
percent in comparison with an increase of about 38 percent for all
auxiliary nursing workers.
5 In 1852, nursing aides in hospitals increased by 14,772 over 1951, representing nearly
half of the total number of additional auxiliary nursing workers, about 3J,000, who entered
hospitals in 1952, according to the Journal of the American Medical Association’s Hospital
Number for May 1953.
AUXILIARY NURSING WORKERS
41
I lie table below shows that the most marked increase in numbers
of auxiliary hospital personnel was for the group of practical nurses
and attendants, and that this represented an increase of 110 percent.
On the other hand, orderlies decreased by nearly 50 percent between
1945 and 1951, and ward maids by more than 20 percent. However,
some of the orderlies may have been counted in the group of attend
ants and practical nurses in 1951.
Table 3.—Auxiliary Nursing Workers
Type of personnel
Total
Practical nurses and attendants
Nursing aides _ _
Orderlies.
Ward maids
in
Hospitals, 1945
and
1945
1951
216, 399
1951 1
Percent
change
297, 466
80,
49,
52,
33,
105
774
654
866
2 167, 977
76, 091
26, 771
26, 627
+ 37. 5
+ 109.
+ 52.
-49.
— 21.
7
9
2
4
1 I' igures are for both men and women, but orderlies are exclusively men, and nursing aides are almost
exclusively women.
2 Practical nurses numbered 40,816 and attendants 127,161.
Source: Journal of the American Medical Association, Hospital Numbers, 1946 and 1952.
Earnings and Hours of Auxiliary Nursing Workers in Hospitals
Only rough estimates of the earnings of women auxiliary nursing
workers may be obtained from a salary survey of untrained women in
hospitals by the American Hospital Association(f). The group of
untrained women includes those who assist in the nursing units, such
as attendants, nursing aides, and ward maids and those working in
service units, such as diet maids, kitchen maids, and cleaners. In 1952,
the gross monthly starting salary for all untrained women hospital
workers (except for Federal hospitals) ranged from $108 to $165 when
grouped according to region, and from $126 to $174 when grouped
according to size of hospital. The average gross monthly salary for
untrained women beginners in 1952 was $132, as compared with an
average of $154 for men in the same group. For clerks (men and
women) the median was $160 and for practical nurses, $164.
In 1952, salaries of untrained women hospital workers had increased
43.5 percent over 1945. The 1952 increase over 1951 was 3.1 percent.
In Federal hospitals, the monthly gross starting salary for untrained
men and women nursing workers was $202 for a 40-hour week in 1952.
For all hospitals except those under Federal control, the average
workweek for untrained women nursing workers in 1952 was 44 hours
42
OUTLOOK FOR WOMEN
among 2,711 hospitals reporting. In 1945, the average for the same
group was 48. When hospitals were grouped according to region for
1952, hours ranged from an average of 41 for the Pacific region to an
average of 46 for South Atlantic, East South Central, and West South
Central regions.
The Future for Auxiliary Workers on the Nursing Team
A number of reports had been accumulated by 1953 about experi
ments and pilot programs in the extensive use of auxiliary personnel to
relieve more highly specialized hospital personnel, especially profes
sional nurses and nursing supervisors, of routine duties. Many more
studies were in progress, both at individual hospitals and schools of
nursing, and under the sponsorship of professional nursing organiza
tions and universities. Some were being financed through special
grants. For example, part of a $100,000 Rockefeller research grant to
Columbia University in September 1952 was set aside for studies of
the nursing function—or job breakdown for nursing personnel.
Other studies were being conducted under the guidance of groups of
professional nurses themselves, such as one project on the nursing
function which was paid for partly through funds raised by the mem
bership of the California State Nurses' Association with financial as
sistance from the national office of the American Nurses’ Association
{2It). In the California study, 42 hospitals representing a variety of
sizes, locations, and types of control were selected for the research. In
February 1953. the study was entering its third year.
The studies on the nursing function were seeking an answer to the
basic question of the effective use of nursepower at all levels of train
ing and job assignment. Among the specific points raised was the
problem of what ratio of various types of personnel—auxiliary work
ers, practical nurses, and professional nurses—was required to meet
the Nation’s demand for nursing care. It had been recognized long
before 1953 that the problem was complex, and that all estimates of
nationwide supply and demand would have to depend on much re
search, which could be satisfactorily carried out only at the nursepatient level.
The current studies seem to be in general agreement on two broad
findings:
(1) That the ratio of professional nurses, trained practical nurses,
and auxiliary nursing workers must be adapted to a particular
kind of patient service in the hospital, to the organization of
the individual hospital, and to other variable factors; and
that
(2) auxiliary workers, as well as practical nurses, could be em
ployed and trained in much greater numbers than were cur
rently available to relieve professional nurses.
auxiliary nursing workers
43
X1ie President s Commission on Health Needs recommended in
1952 that the 1960 need for auxiliary nursing workers would be more
than 450,000, including trained practical nurses, of which 10,000 were
required {21). In March of 1953, a report of the Joint Commission
for Improvement of Care of the Patient (JCICP)6 included a num
ber of recommendations for the increased use and inservice training
of all classes of auxiliary nursing personnel. Simultaneously, the
American Nurses’ Association published a statement made by a repre
sentative group of nursing organizations 7 to the President’s Commis
sion on Health Needs in which it was concluded that, “studies and
experience have demonstrated that 50 percent or over of the total
activities required in nursing units in hospitals can be effectively per
formed by this group” (i. e., attendants, aides, and orderlies) (IJ).
Concerning ratios, a great many variations in hospital staffing pat
terns have been worked out. For example, in a Harper Hospital
Study from 1950 to 1952 (12), the following ratios of nursing per
sonnel were developed for a surgical service unit:
Professional nurses)________________________________
Practical nurses
Nursing aides_________________________________
Clerical workers
Pprrpwf
20
20
415
For a medical service unit the pattern varied as follows:
Professional nurses____________________________
Practical nurses_________________________________
Auxiliary workers
-j 7
Clerical workers____________________________
(y4g
}\ £
U
H
Another study on nursing function conducted at Providence Hos
pital in the District of Columbia by the Catholic University School
of Nursing Education, for 1 year ending in March 1950, reported
that 50 percent of all nursing activities were spent in service for
patients and 50 percent in nursing care; that changes in ratios be
tween professional nurses and auxiliary nursing workers produced
significant changes in distribution of job duties and in the quality of
musing care for patients, and that, in connection with this particular
study, a proportion of 2 auxiliary nurses to 1 professional nurse
worked best in the medical and surgical service unit under study (,9).
These are only several isolated examples from a continually increasing
fund of information about the effective distribution of auxiliary nurs
” Originated in 1948 by the American Medical Association; consisted of 6 doctors 6
,’1UriSnS;„ar"! 6 hospital administrators appointed by representative agencies; began work
m 1949. Nursing organizations represented are the American Nurses’ Association and
the National League for Nursing.
7 Nursing organizations represented the American Nurses’ Association, the National
League for Nursing, the National Association for Practical Nurse Education, and the
National Federation of Licensed Practical Nurses.
44
OUTLOOK FOR WOMEN
ing workers in relation to professional nurses and the nursing-team
idea.
There is general agreement also that the idea of a nursing team is
not new. Hospitals and some public health agencies have used a
team approach for many years. Operating teams have worked ef
fectively in hospital surgical units almost universally. The Eliza
beth Steel Magee Hospital in Pittsburgh reports special team experi
ence with professional nurses and practical nurses and ward helpers
since 1921 (8). But there are many new ideas concerning the ef
fective use of teams and the possibilities for auxiliary nursing workers
as an important part of health teams in hospitals, private home nurs
ing, in public health agencies, and in industrial health units.
Most of the new ideas and the new nationwide interest have de
veloped as a result of the wartime and postwar shortage of nursing
personnel, but also as a result of very considerable changes in medical
treatment which have introduced new drugs, new equipment, new
methods, and, in many cases, new attitudes toward the patient. An
example of the latter is the change in medical treatment after surgery,
when the patient is encouraged to walk and move as soon as possible.
“Early postoperative ambulation,” as it is known, renders a patient
“convalescent” from “acutely ill” in a much quicker time than before,
and the reduction of the amount of time spent by patients in the
“acutely ill” stage obviously reduces the amount of close, personalized
nursing care which a professional nurse is required to provide. In
this situation, the practical nurse and the auxiliary nursing worker
can be assigned a much larger part of nursing care than ever before.
It also becomes of considerable importance that, with the use of
larger numbers of auxiliary nursing workers, the doctor and the
professional nurse must be available to make decisions concerning the
type and amount of care the patient needs. Thus the doctor and all
classes of nursing personnel are drawn together in a close team re
lationship.
Suggestions to Women Interested in Auxiliary Nursing Jobs
Most women who would like to enter hospital work and who can
not spend any time for advance training, or who are not certain about
their long-range interests, can easily afford to risk hospital employ
ment experience as a nursing aide, attendant, or a ward maid or
diet maid. Job opportunities are plentiful, the need is very great in
1953, and it looks as if the demand for auxiliary nursing workers will
continue for some time. It is not necessary for the job applicant to
know many of the technical matters which have been discussed in
this report about auxiliary nursing employment. The selection of
a particular job must meet certain requirements for the individual
woman in matters of salary, hours of work, and location. If oppor
AUXILIARY NURSING WORKERS
45
tunities for advancement are sought, however, it is wise to select a
hospital or health agency which has a well-organized on-the-job train
ing plan, and questions about training may be directed to the employer
under consideration. And, of course, all kinds of questions about
employment opportunities may be directed to the high-school coun
selors by young women in school, and to State employment agencies
and nurse registries.
Some of the inquiries which a job candidate may ask about an
auxiliary nursing job are: Who will supervise me? Who will show
me how to do the work ? Will I have a chance to work in several differ
ent places in the hospital ? Do I have a chance for advancement (with
or without training outside) ? The advice on the last question will
usually end with a recommendation for additional outside training,
which means making plans to enter a program of practical nurse edu
cation, or a school of professional nursing. A tour of duty in the
hospital as a nursing aide, attendant, or diet maid will help women who
are doubtful to make up their minds about the nursing vocation—and
it may also lead to very satisfactory and rewarding permanent
employment.
Requirements to enter auxiliary nursing jobs are summarized
briefly: good physical and mental health; ability to follow instructions
carefully; ability to work with all kinds of people; and an interest in
patients and in the work of the hospital, institution, or public health
agency.
Nursing aides and other members of the nursing team (except stu
dent nurses) are eligible for old age and survivors insurance protection
under the same conditions as are practical nurses employed in hos
pitals and institutions (see p. 21).
APPENDIX
1.—Job Descriptions for Practical Nurse and Nurse Aide in Hospitals (31)
NURSE, PRACTICAL
2-38.201
Jon Summary
Under supervision of physician or professional nurse, administers routine
services in caring for selected subacute, convalescent, and chronic patients, and
assists nurse in care of the more acutely ill.
Performance Requirements
Responsibility for.—Providing suitable environment for patient. Administer
ing personal hygienic and therapeutic measures for patients as directed. Assist
ing with diagnostic procedures. Applying dressings, binders, ointments, pow
ders, and other aids as prescribed by professional nurse or physician. Admin
istering first aid during emergencies. Following other instructions issued by
physician and/or professional nurse.
Physical demands.—Good physical and mental health. Must be able to with
stand strenuous physical activity. Manual dexterity to handle instruments and
equipment.
Special demands.—Must have a liking for people and a desire to serve those
who are ill or incapacitated. Ability to work under close supervision, and to
follow verbal and written instructions. Must be able to adjust self to diversified
types of personalities, and use tact and judgment in dealing with varying
situations.
Qualifications
Education.—Two to four years’ high-school education for applicants under 25
years of age, and completion of at least the 8th grade for those over 25. Com
pletion of an organized course of study approved by the State accrediting agency,
consisting of 9 to 18 months’ theoretical instruction, clinical experience in hos
pitals, and supervised experience in homes, leads to trained practical nursing.
Many States require license for Nurse, Practical.
Training and experience.—On-the-job training. Home-nursing or first-aid
courses offered by vocational and high schools or through other community
facilities, as the YWCA and Red Cross, may shorten training time for students.
Job knowledge—Daily hygienic care of patients. Techniques of moving
patients and assisting them to and from bed. Serving and feeding adults and
children. Techniques of administering such treatments as enemas and stupes.
Preventing spread of disease by proper disposal of Infected material and cleaning
of equipment. Requirements for and method of setting up patient units.
Sterilization of equipment and supplies, and method of handling sterile mate
rial under supervision. First-aid assistance to render in emergencies. Care
of household equipment and operation of appliances. Functions of other hos
pital departments.i
i Code number used in U. S. Department of Labor’s Dictionary of Occupational Titles.
46
APPENDIX
47
Employment Variables
National affiliations.—National Association for Practical Nurse Education,
National Federation of Licensed Practical Nurses.
Working Environment
NURSES, PRACTICAL, are employed in homes, hospitals, institutions, public
health agencies, and doctors’ offices. The conditions under which she works
vary with the type of employment. While working in some types of homes,
the environment may be very disagreeable due to inadequate housing for the
number of occupants; lack of adequate supplies and sanitary facilities; or
poor family relationships.
Job Relationships
Source of workers.—Midwives and practical nurses.
Promotion from.—No formal line of promotion.
Promotion to.—No formal line of promotion.
Super vised by. A member of nursing staff, depending on organization of
hospital.
Workers supervised.—None.
Interrelationship.—Some aspects of this job are similar to NURSE AIDE,
and that of a general housekeeper or homemaker, particularly when employed in
private homes.
Work Performed
As directed, performs any or all of the following duties:
Care of patient.—Escorts newly admitted patients from admitting office to
hospital room or ward and assists them in undressing. Secures necessary hos
pital clothing. Takes and records temperature, pulse, and respiration. Stores
patients’ clothing and valuables, returning property to patients on discharge.
Bathes bed patients or assists with their bath. Combs hair, cleans and cuts
patients’ nails, gives mouth washes, assists in cleaning teeth, and gives sham
poos. Renders afternoon and evening care by bathing patient’s face and hands,
massaging back with alcohol, straightening bedclothes, and leaving room in
order. Feeds patients and serves between-meal nourishment. Drapes patients
for various types of examinations. Administers enemas, douches, perineal
care, and other treatments, as directed. Keeps under constant surveillance
patient recovering from anesthesia or receiving prolonged intravenous or sub
cutaneous injections, notifying professional nurse of unusual reactions such as
cyanosis, weak pulse, excessive respiratory rate, and stoppage of liquid flow
into patient’s body. Applies hot and cold compresses and packs, ice collars
and ice bags, and hot water bottles. Passes and empties bedpans and collects
urine and fecal specimens. Keeps record of patient’s food intake and output
as ordered. Answers signal light or bell and delivers messages. Assists pa
tients in walking and transports patients to various hospital departments by
means of wheelchair or stretcher. Dresses pressure sores and prepares and
applies poultices. Installs and changes abdominal and T-binders. Assists in
giving post-mortem care. Cleans and fills water pitchers for patients. Observes
precautionary measures when caring for communicable cases by dressing in
gown and mask, and washing hands and contaminated equipment with anti
septic solutions before removal from room. Treats body wastes and contam
inated linens with germ-killing solutions before disposal.
Performs related duties.—Changes linens on occupied and unoccupied beds,
and makes up various types of beds such as open, closed, recovery or ether, and
48
OUTLOOK FOR WOMEN
open-air beds, and cribs and bassinets. Cleans, sterilizes, and airs beds after
discharge of patients. Cleans workrooms, linen closets, and medicine cabinets.
Collects and bags soiled linen, and stores clean linen. Washes and scrubs
instruments, equipment, and furnishings. Makes up packs of supplies and instru
ments, dressing and treatment trays, and solutions for sterilizing. Sterilizes
instruments and supplies by soaking in antiseptic solutions, by boiling, or by
autoclave method. Arranges and cares for patients’ flowers. Sets up and
serves food trays.
NURSE AIDE 2-42.20
Job Summary
Assists professional nursing staff by performing routine duties in caring for
hospitalized patients.
Performance Requirements
Responsibility for.—Handling and serving patients in a manner conducive to
their safety and comfort. Adhering to instructions issued by nurse and to es
tablished hospital routine. Performing duties in accordance with established
methods and techniques and in conformance with recognized standards. Pro
viding maximum patient-care services within limits defined by delegated tasks.
Physical demands.—Good physical and mental health. Constant standing and
walking during work periods. Turning, stooping, bending, stretching, and lift
ing to assist patients, make beds, move equipment, and perform other related
tasks. Finger and hand dexterity to handle delicate instruments and other
equipment.
Special demands.—Willingness to work with realization that errors may have
serious consequences for patients. Patience and tact in dealing with ill patients,
many of whom are suffering intense pain. Some initiative and judgment in rec
ognizing symptoms indicative of patients’ adverse reactions to treatments.
Willingness to perform a variety of simple repetitive tasks, many of which in
volve unpleasant conditions. Rapidity and accuracy in preparing instruments
and supplies for use within very limited period of time. Works under close
supervision.
Quai.ifications
Education.—A minimum of grammar-school education is essential, and highschool education or equivalent is preferred.
Training and experience.—Previous experience preferable, but not essential.
Worker receives on-the-job training under close supervision.
Job knowledge.—Knowledge of procedures and techniques involved in admin
istering siruple treatments and providing related bedside patient-care service.
Familiarity with location of various departments and with general regulations
of hospital. Understanding of standard techniques used in providing personal
services for patient and in caring for equipment and supplies. Good under
standing of basis of asepsis and sterile techniques to avoid infection of patients
and self or contamination of equipment and supplies.
Employment Variables
May be required to work in rotating shifts.
.
Working Environment
Works inside well-lighted and ventilated hospital rooms. Possibility of cuts
from sharp instruments, burns from sterilizing equipment, and infections from
soiled linen. May be exposed to communicable diseases. Subjected to dis-
APPENDIX
agreeable odors from patients, anesthesia, or disinfectants.
strains due to lifting patients or handling heavy equipment.
49
Possibility of
Job Relationships
Source of workers.—Attendants in hospitals, and other institutions, not else
where classified.
Promotion from.—This is an entry job.
Promotion to.—No formal line of promotion.
Supervised by.—A member of nursing staff, depending on organization of hos
pital.
Workers supervised.—None.
Interrelationship.—Some aspects of this job are similar to those of NURSE
PRACTICAL; ORDERLY. Depending upon size and organization of hospital,
sterilizing of instruments and equipment may be done by nursing staff or
ORDERLY, and cleaning of rooms and equipment may be performed by MAID •
or PORTER.
’
Work Pebformed
Performs various patient-care services.—Escorts newly admitted patient from
admitting office to hospital room or ward, assists her in undressing, and pro
vides necessary hospital clothing. Stores patient’s clothing and valuables, re
turning property to her on discharge. May take and record temperature, pulse,
and respiration rate. Bathes bed patient or assists her in bathing herself. Combs
hair, cleans and cuts patient’s nails, gives mouth washes, assists in cleaning
teeth, and gives shampoos when necessary. Gives alcohol rubs. Feeds very ill
patients, assists other patients with their meals and provides between-meal
nourishment when it is indicated. Drapes female patients for examination.
Passes and empties bedpans and collects urine and fecal specimens. Keeps
record of patient’s food intake and output when ordered. Answers signal li«ht
or bell and delivers messages. Assists patient in walking and transports patient
to various hospital departments by means of wheelchair or stretcher.
^ Performs related duties.—Cleans room and equipment on discharge of patient.
Cleans workrooms, linen closets, and medicine cabinets. Changes covers on
stretchers, examining tables, and screens. Collects charts, records, and reports
Collects and bags soiled linen and stores clean linen. Cleans and sterilizes in
struments and equipment. Receives and escorts visitors. May help with post
mortem care.
2.
Approved Practical Nurse Training Programs in United States and
Territories, September 1952
PUBLIC EDUCATION
. ?!lUrCe, i TraT*‘“"'I Industrial Education Branch, Division of Vocational Education, Office
of Education, U. S. Department of Health, Education, and Welfare, Washington 25, D. C.
Alabama
Birmingham:
Birmingham Public Schools (Negro).1
Paul Hayne Vocation School.1
Wenonah Vocational Trade School (Negro).1
Dotlian : State Vocational Trade School.1
Gadsden : Alabama School of Trades.1
'Program approved by State Board of Nursing Education and Nurse Registration.
- Program approved by National Association for Practical Nurse Education.
OUTLOOK FOR WOMEN
50
Mt. Edgecumbe: Mt. Edgecumbe Vocational School (native girls)/
Arizona
Phoenix: Phoenix Technical School.2
Arkansas
Little Rock: Little Rock Trade School.1
Camden: Ouachita County Hospital.
Pine Bluff: Davis Hospital Annex.
California
Berkeley : Berkeley Evening School.
Fullerton: Fullerton Junior College.2
Fresno : Fresno Junior College.
Kenfield : Marin Junior College.
Long Beach: Long Beach City College.
Los Angeles:
East Los Angeles Junior College.2
Los Angeles Trade-Technical Junior College.
Martinez: Contra Costa Junior College.
Monterey: Monterey Union High School.
Oakland: Joseph C. Laney Trade and Technical Institute.
Pasadena: Pasadena Junior College.2
Salinas: Salinas Evening Junior College.
_
San Diego : San Diego Vocational High School and Junior College.
San Francisco: Galileo High School.
Stockton: Stockton Evening College.
Colorado
Denver:
General Rose Hospital.
Denver General Hospital.
St. Luke’s Hospital.
Durango : Mercy Hospital.
Grand Junction: St. Mary’s Hospital.
Connecticut
Bridgeport: St. Vincent's Hospital1
New Britain: E. C. Goodwin Technical School.1
New Haven: Grace Hospital.1
Delaware
Wilmington : H. Fletcher Brown Vocational High School.
District of Columbia
Washington:
_
Anna Burdick Vocational High School.2
a
Margaret Murray Washington Vocational High School (Negro).
Florida
Daytona Beach: Mary Karl Vocational School.
Jacksonville:
Duval County Negro Vocational School.1
Jacksonville School of Technology.1
Miami: Lindsey Hopkins Vocational School.1
Pensacola: Pensacola Vocational School.1
St. Petersburg:
Gibbs Vocational School (Negro).1
Tomlinson Vocational School.1
Tampa : Brewster Vocational School.1
1 and 2, see p. 49.
APPENDIX
51
Hawaii
Honolulu: Washington Intermediate School.1
Idaho
Blackfoot: Bingham Memorial Hospital.1
Boise:
St. Alphonsus Hospital.1
St. Luke’s Hospital.1
Caldwell: Caldwell Memorial Hospital.1
Cottonwood: Our Lady of Consolation Hospital.1
Downey: Marsh Valley Memorial Hospital.1
Emmett: Mary Secor Hospital.1
Orangeville: General Hospital.1
Idaho Falls: Sacred Heart Hospital.1
Lewiston: St. Joseph’s Hospital.1
Pocatello : St. Anthony Mercy Hospital.1
Rexburg: Madison Memorial Hospital.1
Sandpoint: Bonner General Hospital.1
Twin Falls : Magic Valley Memorial Hospital.1
Wallace:
Wallace Hospital.1
Providence Hospital.1
Weiser : Weiser Memorial Hospital.1
Illinois
Chicago:
Manley Vocational School.1 8
Princeton Vocational School.1 2
Indiana
Indianapolis: Indianapolis Public Schools.1 2
Kansas
Kansas City: University of Kansas, Florence Cook Department of Practica1
Nursing.1 2
Kentucky
Louisville:
Red Cross Hospital (Negro) ?
Louisville General Hospital.1
Louisiana
Baton Rogue: Baton Rouge Trade School.
Crowley: Southwestern Trade School.1
Lake Charles: Southwest Louisiana Trade School.1
New Orleans:
Booker T. Washington School (Negro).1
L. E. Rabouin Vocational School.1
Opelousas: T. H. Harris Trade School.
Shreveport:
Caddo Parish School (Negro).1
Shreveport Trade School.1
West Monroe : Ouachita Valley Vocational School.1
Massachusetts
Springfield : Springfield Trade School.1
1 and 2, see p. 49.
OUTLOOK FOR WOMEN
52
Michigan
Ann Arbor: Jones High School.1
Battle Creek : Southwestern Junior High School.1
Detroit: Goldberg Trade School.1 2
Mint: Flint Public Schools.1 2
Grand Rapids: Grand Rapids Junior College.1 2
Lansing : Lansing Technical High School.1 2
Marquette: Graveraet High School.1
Traverse City: Traverse City High School.1
Minnesota
Duluth: Duluth Area Vocational School.1
Minneapolis:
Minneapolis Vocational High School and Technical Institute.1
University of Minnesota, School of Nursing.1
University of Minnesota, School of Agriculture.3
Thief River: Thief River Falls Area Vocational School.1
Willmar : Willmar Public Schools.1
Winona: Area Vocational School.1
Mississippi
Itta Bena: Mississippi Vocational College (Negro).
Pascagoula: Pascagoula High School.
Missouri
Kansas City:
General Hospital.
General Hospital (Negro).
St. Louis:
Booker T. Washington Technical High School (Negro) .s
Hadley Technical High School.2
Montana
Bozeman: Deaconess Hospital.
Havre : Northern Montana State College.
Nebraska
Omaha: Technical High School.
Nevada
Las Vegas: Las Vegas High School.
New Jersey
Atlantic City: Atlantic City Vocational-Technical High School.1
Newark: Essex County Voeational and Technical High School.1
Woodbridge: Middlesex County Girls’ Vocational School.1
New York
Ithaca : Ithaca High School.1
Jamestown : Jamestown High School.1
Morrisville: New York State Agricultural and Technical Institute.1
Niagara Falls : Trott Vocational High School.1
Rochester: Jefferson High School.1
Syracuse: Hurlbut W. Smith Technical and Industrial High School.1
and
see p. 49.
APPENDIX
North Carolina
Albemarle: Stanley County Hospital.1
Ashboro: Randolph County Hospital.1
Banner Elk: Grace Hospital.1
Burlington : Almanaee General Hospital.1
Durham: Hillside High School (Negro).1
Goldsboro: Wayne County Memorial Hospital.1
Raleigh : Mary Elizabeth Hospital.1
Washington: Tayloe Hospital.1
North Dakota
Wahpeton: North Dakota State School of Science.1
Ohio
Akron : Hower Vocational School.2
Cincinnati: East Vocational High School.2
Cleveland: Jane Addams Vocational School.2
Dayton : Barker Vocational School.
Toledo: Sherman School.2
Youngstown: Girls’ Vocational High School.
Oregon
Portland: Girls’ Polytechnic High School.1
The Dalles: The Dalles Practical Nurse School.1
Pennsylvania
Philadelphia:
Edward Bok Vocational Technical School.1
Jules E. Mastbaum Vocational School.1
University of Pennsylvania, Graduate Hospital.1
Pittsburgh: Irwin Avenue Vocational School.1
Rhode Island
Providence : Oliver Hazard Perry Junior High School.1
South Carolina
Greenville: Greenville Senior High School.1
Lancaster: Lancaster City College (Negro).1
South Dakota
Pierre: Pierre High School.1
Tennessee
Chattanooga:
City Public School (Negro).1
City Public School.1
Crossville: Cumberland County Medical Center.1
Jackson:
Jackson Public School (Negro).1
Jackson Public School.1
Kingsport: Dobyns-Bennett High School.1
Memphis:
Booker T. Washington High School (Negro).1
Memphis Vocational School.1
Nashville:
Hume-Fogg Technical and Vocational High School.1
Pearl High School (Negro).1
1 and 2, see p. 49.
53
OUTLOOK FOR WOMEN
54
Texas
Amarillo: Amarillo College.1
Beaumont : Lamar State College of Technology.
Corpus Christi: Del Mar College.12
Dallas:
Dallas Independent School (Negro).1
Dallas Independent School.1
El Paso: El Paso Technical Institute.
Fort Worth: Fort Worth Technical Institute.1
Houston:
Houston Independent School (Negro).
University of Houston.12
Odessa: Odessa Junior College.
San Angelo: San Angelo Independent School.1
San Antonio : San Antonio Vocational and Technical School.
Temple: Temple Independent School.1
Tyler: Tyler Junior College.1
Wharton: Wharton County Junior College.1
Utah
Provo : Central Utah Vocational School.12
Salt Lake City : Salt Lake Area Vocational School.1
Virginia
Charlottesville: Jackson P. Burley High School (Negro).1
Hampton: The Dixie Hospital (Negro).
Norfolk : Leigh Memorial Hospital.12
Richlands: Clinch Valley Clinic Hospital.1
Richmond:
John Marshall High School.1
Maggie Walker High School (Negro).1
Fishersville: Wilson Memorial High School.1
Washington
Aberdeen: Grays Harbor Junior College.
Bremerton: Olympia Junior College.1
Everett: Everett Junior College.1
Seattle: Edison Technical School.1
Spokane: Spokane Trade School.1
Tacoma : Tacoma Vocational Technical School.1
Vancouver: Junior College.
Wenatchee: Wenatchee Junior College.
Yakima: Yakima Junior College.1
Wisconsin
Kenosha: Kenosha School of Vocational and Adult Education.1
Madison: Madison Technical and Adult School.1
Milwaukee : Milwaukee Institute of Technology.1
Neenah: Neenah-Menasha School of Vocational and Adult Education.1
PROGRAMS OTHER THAN PUBLIC EDUCATION
Alabama
Selma : Good Samaritan Hospital (Negro).1
Arizona
Ganado : Sage Memorial Hospital.
3 and J, see p. 49.
APPENDIX
Arkansas
Little Rock: Little Rock Baptist Hospital.1
California
Long Beach: Seaside Memorial Hospital.2
Colorado
Colorado Springs : Glockner-Penrose Hospital.2
Denver: St. Anthony’s Hospital.
Pueblo : St. Mary’s Hospital.
District of Columbia
Washington : Walter Reed Army Medical Center.2
Florida
Miami: Mt. Sinai Hospital.1 2
Georgia
Atlanta : Acomsinc School of Practical Nursing.
Iowa
Marshalltown : Mercedian School for Practical Nurses.1
Kansas
Leavenworth: Sisters of Charity School for Practical Nurses.1
Kentucky
Lexington: Appalachian School of Practical Nursing.1
Louisiana
New Orleans : Charity Hospital.1 2
Maryland
Baltimore:
Baltimore City Hospital.1
Home for Incurables.1
South Baltimore General Hospital.1
Cambridge:
Cambridge-Ma ryland Hospita 1 -1
Eastern Shore State Hospital.1
Crownsville: Crownsville State Hospital.1
Henry town: Henrytown State Hospital (Negro)
Owings Mills : Rosewood State Training School.1
State Sanatorium: Victor Cullen State Hospital.1
Sykesville : Springfield State Hospital.1
Massachusetts
Beverly: Beverly Hospital.1
Boston: Household Nursing Association.1
Boston Harbor : Long Island Hospital.1
Brookline: Booth Memorial Hospital.1
Cambridge: Holy Ghost Hospital.1 2
East Gardner : Gardner State Hospital.1
Gloucester : Addison Gilbert Hospital.1
Hyannis: Cape Cod Hospital.1
Tewksbury : Tewksbury State Hospital and Infirmary.1
Walpole: Pondvllle Hospital.1
Westborough: Westborough State Hospital.1
Westfield : Westfield State Sanatorium.1
Winthrop: Winthrop Community Hospital.1
1 and >, see p. 49.
55
56
OUTLOOK FOR WOMEN
Michigan
Cadillac: Mercy Hospital.1
Mt. Clemens: St. Joseph’s Hospital.
Minnesota
Crookston: Bethesda Hospital.1
Mankato : St. Joseph’s Hospital.1
Minneapolis: Franklin Hospital.1
New Ulm : Union Hospital.1
Rochester : St. Mary’s Hospital.1
St. Paul: Charles T. Miller Hospital.1 2
Mississippi
McComb: McComb Infirmary.
Meridian : St. Joseph’s Hospital.
Nebraska
Omaha: St. Joseph Hospital.
New Mexico
Albuquerque: St. Joseph Hospital.
Santa Fe: St. Vincent Hospital.
New York
Albany:
Albany Training School for Practical Nurses.1
Child’s Hospital.1
Brooklyn :
Brooklyn YWCA (Central Branch).1
Caledonian Hospital.1
Wyckoff Heights Hospital.1
Glen Cove : North Country Community Hospital.1
New York:
Central School for Practical Nurses, Welfare Island.1
Harlem YWCA School for Practical Nurses.1
Hospital for Joint Diseases.15
Montefiore Hospital.1 2
Yonkers: St. Joseph’s Hospital.1
North Carolina
Candler : Pisgah Sanitarium and Hospital.1
Durham: AVatts Hospital.1
Ohio
Cincinnati: Good Samaritan Hospital.1
Cleveland : Family Health Association.2
Garfield Heights: Marymount Hospital.2
Springfield: Mercy Hospital.2
Oklahoma
Blackwell: Blackwell General Hospital.1
Lawton: Kiowa Indian Hospital (Indian girls only).1
Pennsylvania
Cresson: State Tuberculosis Sanatorium No. 2.‘
Puerto Rico
Areciho : Hospital Municipal de Arecibo.1
Santurce: Clinica Percia Leal.1
and 2, see p. 49.
APPENDIX
57
South Carolina
Charleston: Roper Hospital.1
Florence: Saunders Memorial Hospital.1
Tennessee
Greenville: Takoma Hospital and Sanitarium.1
Madison College: Madison College (Negro).1
Nashville: Riverside Hospital (Negro).1
Texas
Austin: Holy Cross Hospital.12
Brady: Brady Hospital.1
Denton: Flow Memorial Hospital.1
Fort Worth: All Saints Hospital.1
Ganado: Mauritz Memorial Jackson County Hospital.1
Halletsville: Renger Memorial Hospital.1
Hillsboro: Hillsboro Clinic Hospital.1
Kenedy: Kenedy Clinic and Hospital.1
Meridian: Holt Hospital.1
Sherman: Wilson N. Jones Hospital.1
Taylor:
Johns Clinic and Hospital.1
Stromberg Clinic and Hospital.1
Swanson Clinic and Hospital.1
Waco: Baylor University.12
Vermont
Bennington: Putnam Hospital.1
Brattleboro: Thompson School for Practical Nurses.1
West Virginia
Glen Dale: Reynolds Memorial Hospital.2
3-—Practical Nurse Positions in the Federal Civil Service3
Minimum Requirements
Age.—Applicants must have reached their 18th birthday on or before the date
of receipt of their application for this examination.
Physical Requirements—Persons having physical handicaps which they believe
will not prevent their satisfactory performance in the position are invited to
aPPly: however, applicants must be physically capable of performing the duties
of the position efficiently, and must he free from such defects or diseases as
would constitute a hazard to themselves and others. Applicants must be able
to distinguish shades of colors, be able to hear the whispered voice, and possess
emotional stability.
< ilizenship. Applicants must be citizens of or owe allegiance to the United
States (this latter group consists only of natives of American Samoa).
Training. Applicants must have successfully completed one of the following:
A. Plaining for practical nurses consisting of a minimum of 400 hours of
theoretical instruction and supervised demonstrations in an approved school of
practical nursing which included a minimum of 1,200 hours of supervised nursing
care of patients as a part of the course,
1 and 2, see p. 49.
3 From Civil Service Announcement No. 4-32-2 (1953). Specifically for
employment in
tlm National Institutes of Health, Bethesda, Md. Openings exist in other
locations from
time to time, for which the description of work may differ slightly.
OUTLOOK FOR WOMEN
58
or
B. A United States Army course for medical and surgical technicians,
or
C. A United States Navy course for Navy hospital corpsmen,
or
D. A United States Coast Guard hospital corps training course,
or
E. A United States Maritime Service hospital training course,
or
F. A Bureau of Indian Affairs, United States ! lepartment of the Interior,
Kiowa Indian Hospital course for practical nurses (formerly known as the
Kiowa Nurses’ Aide School).
Experience.—Graduates of the Army technician course, the Navy Hospital Corps
course, and the courses for the Coast Guard and Maritime Service personnel,
following the date of successful completion of the course, must have had a mini
mum of 6 months' successful nursing experience on active duty as Army medical
or Army surgical technician, as Navy hospital corpsman, or pharmacists’ mate
in one of the Army, Navy, or United States Public Health Service (Marine)
Hospitals under the supervision of qualified professional nurses and physicians.
Experience and/or training such as inservice attendant training, first-aid,
home nursing, correspondence and other courses which do not provide supervised
practice under qualified professional nurses in a hospital, are not considered as
meeting any of the basic requirements to qualify for this position. However,
applicants whose experience and/or training meet all basic qualifications
requirements, should, in addition, indicate any such training and experience such
as that mentioned immediately above, since it may be of value as supplementing
required qualifications standards.
Written examination.—All competitors will be required to take a written
examination testing ability to learn and adjust to the duties of the position.
Approximately 2 hours will be required for the written examination.
Salary
and
Workweek
Salary is based on the standard Federal workweek of 40 hours. Additional
compensation is provided for any authorized overtime worked in excess of the
40-hour week. The salary range for the grade of this position is given below.
For employees whose services meet prescribed standards of efficiency, the en
trance salary is increased by the amount shown in the table, following the com
pletion of each 02 weeks of service until the maximum rate for the grade is
reached. All basic salaries are subject to a deduction of 6 percent for retirement
purposes.
Grade of position
Entrance salary
Periodic increase
Maximum basic salary
GS-3
$2,950
$80
$3,430
Description
of
Work
Trained practical nurses participate as members of the nursing team in the
care of patients in the following nursing sections: heart, cancer, arthritis and
metabolic, psychiatric, infectious and tropical diseases, neurological diseases and
blindness, follow-up (admissions and outpatient), and operating room; partici
pate in providing a safe, comfortable, attractive environment for patients; pro
viding nursing care necessary for the patients’ well-being; carrying out diagnos
tic tests and procedures, assisting with preoperative and postoperative treat
ments and care; orienting patients to the hospital, providing recreational, diversional and social activities, and maintaining nursing records as assigned.
APPENDIX
59
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OUTLOOK FOR WOMEN
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APPENDIX
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62
OUTLOOK FOR WOMEN
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O
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