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THE
OUTLOOK
FOR
WOMEN

Professional
Nursing Occupations

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MEDICAL SERVICES SERIES
Bulletin No. 203-3, Revised
U. S. DEPARTMENT OF LABOR
Martin P. Durkin, Secretary
WOMEN’S BUREAU
Frieda S. Miller, Director

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UNITED STATES DEPARTMENT OF LABOR
MARTIN P. DURKIN, SECRETARY

WOMEN’S BUREAU
FRIEDA S. MILLER, DIRECTOR

The Outlook for Women
in
Professional Nursing
Occupations
Bulletin of the Women's Bureau No. 203-3, Revised
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 30 cents

THE PROFESSIONAL NURSE
This bulletin deals with the PROFESSIONAL NURSE, an occupational
title which identifies those nurses who (1) have successfully completed
a minimum of 3 years of training in an accredited and State-approved
school of nursing, and (2) have passed a State licensing examination.
A professional nurse is permitted to add the designation “R. N.” (Reg­
istered Nurse) after her name. She is classified by nursing service
organizations' as a registered professional nurse and may sometimes be
referred to in a general way as a graduate nurse to distinguish her from
the student who has not completed the basic training. The term “trained
nurse,” which is sometimes heard, does not necessarily describe the pro­
fessional registered nurse.
Many professional nurses acquire formal training beyond the basic
nursing school course. Each year an increasing number of women enter
the nursing field with a college degree, usually the Bachelor of Science
in Nursing, which signifies the completion of 4 years of college work.
There are also professional nurses who have taken courses in special
subjects at universities or colleges in order to qualify for certain super­
visory jobs or for employment in a specialized field such as obstetrics,
psychiatric nursing, communicable diseases and many others, for which
advanced training, as well as experience, has become a prerequisite.

This is Bulletin 203-3 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 Occupa­
tions.

LETTER OF TRANSMITTAL

United States Department of Labor,
Women’s Bureau,

Washington, March 30,1953.
Sir : I have the honor of transmitting a revision of the bulletin on
the outlook for women in professional nursing occupations, first
issued by the Women’s Bureau in 1945 as Bulletin 203-3.
Since World War II there has been an increased demand for pro­
fessional nurses and especially for nurses with specialized and ad­
vanced training. Changes in concepts and trends in the entire field
of nursing service, accelerated during the war, have since gained
additional momentum, partly in answer to the pressing need for
nursepower throughout the Nation.
For young women nurse candidates, the outlook is favorably af­
fected, on the whole, by the transitions which are taking place, par­
ticularly in relation to the number and variety of job openings
and the current and anticipated benefits in salaries. At the same
time, candidates for nurse careers are faced with more difficult prob­
lems of selecting appropriate nurse training courses than in former
years, and this situation will continue until nurse education and job
requirements for both professional and practical nurses achieve a
greater degree of standardization than at present.
Because almost every phase of the nursing profession is currently
subject to some kind of reevaluation, this bulletin limits itself to
a summary of the basic considerations involved in training and em­
ployment opportunities, and outlines in broad perspective the nature
of the most significant changes and anticipated revisions in nurse
training and service as a guide primarily to those seeking career
advice in this field.
Information for this bulletin was obtained through personal inter­
views and correspondence with professional organizations, public
and private agencies, hospitals, schools of nursing, and individuals
conversant with the nursing field, and through their published reports,
listed among the references in the appendix. Credit is given on
page 80 for illustrations made available through the courtesy of
cooperating agencies.
in

This bulletin was planned and written in the Employment Oppor­
tunities Branch of the Women’s Bureau Research Division of which
Mary N. Hilton is Chief. The research was supervised and the bul­
letin prepared by Lillian V. Inke, Branch Chief, with the assistance
of Agnes W. Mitchell.
Respectfully submitted.
Frieda S. Miller, Director.
Hon. Martin P. Durkin,
Secretary of Labor.

IV

CONTENTS
I. Professional nursing offers a wide choice of jobs___________________
The basic nursing job
Clinical specialization____________
Job variations according to type of employer________________
Public health nursing jobs
6
Nurse occupations in Federal civilian service _ _
_.........
Military nurse occupations ___________________________
Industrial nursing jobs . _____________________________
Office nurses
12
Nurse instructors_____________________ _
...... ...... .
N urse examiners on State boards. ____________
_
Administrative nursing positions................ _
____
Job combinations with nursing______________ _
___________
Opportunities for nurses in foreign service___________________
II. The outlook ________________________________________________
The demand for more nurse recruits____________
_ ______
Estimates for nursepower _______________________________
Most critical areas of nurse shortage ______________________
The quality shortage_______________ _____________________
Factors affecting the nurse shortage_______
Opportunities for career advancement _____________________
Opportunities for women with special employment problems. _.
III. Distribution of professional nurses_______________________
Significance of occupational distribution____________________
Distribution by type of nurse activity or employer___________
Nurses in hospitals and health institutions______________
Federal Government service
35
Public health nursing—State and local agencies_________
School nurses—public and private ____________________
Industrial nurses._
Office nurses __
Nurse instructors
41
Psychiatric nurses _ _ _______________________________
Tuberculosis nurses ______________________
Nurse-midwives
43
Nurses in foreign service
43
Nurses in the American National Red Cross____________
Nurses in part-time employment
45
Geographic distribution and job opportunities_______________
IV. Training for a nurse career
47
Preparation begins in high school_______________
Minimum requirements for entering nursing schools__________
Nurse training is in transition___ __________________
.__
The hospital school______________
Collegiate schools of nursing___ ____ ___________________
Advanced degrees in nursing___________
Training opportunities in the Commissioned Nurse Corps____
Special training for public health nursing___________________
Scholarships, stipends, and loans
55

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V. Conditions of employment -. __________________________________
Earnings_______________________
Hours________________
—...... ..........
“Fringe” benefits___
- Licensing______
...
VI. Professional nurse organizations
The American Nurses’ Association. _ . _.____ .
----The National League for Nursing_________
____________
VII. Suggestions to the nurse candidate___
. ...............
- —
Making the career choice_____
_____
Selecting the school of nursing.
VIII. Information for the graduate nurse..
Special training _______________ ________ _----------------------Insurance_________________________________
..
Organization membership
Seeking employment.....
Appendix:
1. Minimum requirements for a beginning Federal civil service posi­
tion as a staff nurse for duty in Washington, D. C., and vicinity
and in the Panama Canal zone___________ _ ----------------------2. Minimum requirements for a beginning Federal civil service posi­
tion as a staff nurse for duty in the Indian Service of the U. S.
Department of the Interior.
—--- --------3. Minimum requirements for a beginning Federal civil service posi­
tion as a public health nurse for duty in the Bureau of Indian
Affairs
73
4. Minimum requirements for a beginning Federal civil service posi­
tion as staff nurse, general-duty nurse, ward nurse, and other
positions requiring similar qualifications in various Federal
agencies .-------------------------------------------------------------------------5. Minimum requirements for professional nurses at the Clinical
Center, National Institutes of Health, Bethesda, Md________
6. Institutions offering public health service stipends for advanced
training in psychiatric nursing under the National Mental Health
Act-----------------------------------------------------7. Schools of nursing which offer basic nursing programs to prepare
students for beginning positions in public health nursing under
supervision________________________________________________
8. The military nursingservices
76
References
77
Credit for illustrations
80
Tables:
1. Professional nursing personnel in 6,637 hospitals by type of posi­
tion, 1951
2. Active professional nurses in the United States and territories, by
field of nursing, 1951
3. Nurses employed by the agencies of the Federal Government and
the District of Columbia, 1952 and 1953--------------------------------4. Geographic distribution of graduate nurses in hospitals, number
of hospital beds, and population in the United States, 1951-----Illustrations:
1. Caps designate the schoolfrom which nurses are graduated_____
2. Mothers learn from specially trained nurses how to care for their
children____________________________

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69
70
70

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75

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33
34
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3. Nursing specialties in the Armed Forces_________ _____________
4. A public health nurse presents community education plans_______
5. Navy nurse instructs medical corpsman in care of patient on
hospital ship
________________________________________
6. Maternity ward nurse registers footprint for identification of
newborn child in hospital
_
7. Nurse in physician’s office takes a blood sample for testing_______
8. Nurse training combines classroom work and hospital practice____
9. Industrial nurses treat employees in first-aid room of oil refinery.,
10. A nurse anesthetist
_

10
18
24
35
42
47
60
gg

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Figure 1.—Caps designate the school from which nurses are graduated.
1. Cornell University—N. Y. Hospital. 4. Nebraska Methodist, Omaha.
2. St. Luke’s Hospital, Chicago.
5. Philadelphia General Hospital.
3. Queen’s Hospital, Honolulu, Hawaii. 6. Yale University School of Nursing.

viii

THE OUTLOOK FOR WOMEN IN
PROFESSIONAL NURSING
OCCUPATIONS
I.—PROFESSIONAL NURSING OFFERS A WIDE CHOICE
OF JOBS

The very first jobs in the field of modern nursing were concerned
entirely with the care of the patient in hospitals, private homes, insti­
tutions, or battlefield medical stations. The majority of nursing jobs
are still devoted to patient-centered care, and all professional nurses
must take the basic training relating to the care of the patient. Never­
theless, the variations and job-combination possibilities today extend
even beyond the anticipation of those far-seeing nineteenth century
women who, like Florence Nightingale, worked for the improvement
and extension of nursing services, skills, and opportunities.
Today’s professional nurse has a choice of occupational outlets
which are being multiplied continually by new medical practices and
the extension of health services of all types into the life of the com­
munity. After the basic nurse training the question for the graduate
becomes, “What kind of nursing job do I want?” rather than, “Where
shall I get a job?” It is wise for the nurse candidate to consider as
early as possible the question of career specialization because the
increasing variety of nursing opportunities has made changes in nurse
training. Many jobs or job combinations today require special train­
ing at the college level, in addition to the traditionally acceptable
3-year diploma course.
Jobs listed for nurses in the Dictionary of Occupational Titles
(56) include over 30 variations, but this is by no means an exhaustive
list. A diagram on the following page shows broad occupational divi­
sions in the nursing field which may suggest some of the possible
career directions for the nurse. Not all of the common job titles for
professional nurses are represented in the diagram.
Among job combinations (not on the accompanying diagram) are:
Nurse editor; nurse placement counselor; missionary nurse; nurse
registry director; nurse anesthetist; professional organizer; nurse
technician.

249599—53------ 2

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BROAD OCCUPATIONAL DIVISIONS
IN
PROFESSIONAL NURSING
The basic nursing job is general patient-centered care
GENERAL STAFF NURSE—may work in a hospital, institution,
school, camp, health agency, clinic, infirmary; employers may be
public or private agencies.
INDUSTRIAL NURSE—on general duty in a business or industrial
establishment.
OFFICE NURSE—may work for one or more physicians or dentists.
PRIVATE DUTY NURSE—so-called because she contracts for her
services with a single employer (usually)—may work in a hospital
or in patient’s home.
MILITARY NURSE—in Army, Navy, or Air Force Commissioned
Corps.
With special training and experience, a nurse may become known
by a title to indicate a field of clinical specialization, such as:
MATERNITY NURSE
PSYCHIATRIC NURSE
PEDIATRICS NURSE
NURSE, COMMUNICABLE DISEASE
TUBERCULOSIS NURSE ORTHOPEDICS NURSE
and many others
Jobs in nursing education and licensing:
NURSE INSTRUCTOR
NURSE, BOARD OF EXAMINERS
(usually appointive positions)
EXECUTIVE SECRETARY,
STATE LICENSING BOARD

Additional education and
experience can lead to spe­
cial fields of work and many
job combinations, some of
which move away from
direct patient care.

Supervisory jobs cut across the entire field
of nursing service and education; some
are:
HEAD NURSE
SUPERVISOR
DIRECTOR OF NURSING SERVICE
DIRECTOR OF HEALTH
SUPERINTENDENT OF HOSPITAL OR
INSTITUTION
NURSE CONSULTANT—works in an ad­
visory and planning capacity for health
agencies, industrial establishments, edu­
cational institutions, etc. Nurses may be
employed or appointed in such jobs.

2

Professional nurse job titles need not be confusing to the student
f certain facts about the use of job titles are kept in mind:
1. Alternate titles for the same job are in common use; for ex­
ample, a Surgical Nurse may also be known as an Operating
Room Nurse, and a nurse who works in an operating room may
be called more specifically an Instrument Nurse if her main
duties consist of responsible care of operating room equipment.
2. Some generally descriptive titles such as Private Duty Nurse
or Hourly Nurse are used to indicate the terms of employment
rather than the kind of work performed. A private duty nurse
may be specialized in maternity care or communicable diseases,
and would therefore be entitled to designation according to her
field. Another example is that of Public Health Nurse, which
is a general title for a nurse who works in public health, but who
may be either a general staff nurse or a specialist, as well.
3. Titles for the same job differ from place to place and among
different employers. From time to time real efforts are made
to standardize titles, but progress is slow in this respect, and
there is not always agreement between various authorities. For
example, a national nursing organization may decide to adopt
a certain job title for a defined job, but all of the persons in­
volved in naming the job have their own practices and reasons
for not wishing to conform.
One example of success in achieving a large measure of job
title standardization is the adoption of a number of professional
nurse titles for hospital positions in the publication, “Job De­
scriptions and Organizational Analysis for Hospitals and Re­
lated Health Services” by the United States Department of
Labor in 1952 (57). The rule of the occupational analysts who
study and classify jobs is to use the job title for a specific job
which is most commonly found and to consult with the profes­
sional groups most closely involved to obtain concurrence in
both the title and the job description. (For anyone interested
in pursuing this subject, reference is made to the foreword and
introduction of the report cited.)
The Basic Nursing Job
Because all nursing career variations are solidly based upon training
in, and comprehension of, the personal care and welfare of patients, a
description of the duties and qualifications of a general staff nurse in a
hospital is included to illustrate the basic or core job of nursing. This
job description, which relates to a typical beginning job in hospital
work, is taken from the United States Department of Labor’s Job
Descriptions for Hospitals (57) :

3

General Staff Nurse

Job Summary
Renders nursing care to patients within an assigned unit: Observes
and reports symptoms and conditions of patient. Takes and records
temperatures, respiration, and pulse. Administers medications and notes
reactions. Sets up treatment trays, prepares instruments and other
equipment, and assists physicians with treatments. Assists in administer­
ing highly specialized therapy with complicated equipment. Maintains
records' reflecting patient’s condition, medication, and treatments. Bathes
and feeds acutely ill patients. Assists with research related to improve­
ment in nursing care.
Performance Requirements
Responsibility for: Knowledge of patient’s condition at all times. Pro­
viding nursing care according to physician’s orders and in conformance
with recognized nursing techniques and procedures', established standards,
and administrative policies. Recognizing and interpreting symptoms,
reporting patient’s condition, and assisting with or instituting remedial
measures for adverse developments. Maintaining accurate and complete
records of nursing observations and care. Studying trends and develop­
ments in general nursing practices and techniques and evaluating their
adaptability to specific nursing duties. Assisting in teaching patients
good health habits. Cleanliness of area.
Physicial Demands: Good physical and mental health. Finger and
hand dexterity to handle and manipulate instruments and equipment.
Visual and aural acuity to detect changes in patient’s condition.
Special Demands: Willingness to work with realization that incompe­
tence and errors may have serious consequences for patients. Under­
standing, patience, and tact in dealing with ill patients, many of whom
are suffering intense pain, and with visitors. Ability to maintain good
working relationships with personnel of unit and with medical staff.
Memory for details. Alertness and skill in recognizing and identifying
symptoms, and initiative and judgment in selecting proper treatment for
unusual or unfavorable conditions. Resourcefulness in emergency situa­
tions. Works under general supervision.
Qualifications
Education: Graduation from accredited school of nursing; current
registration with State board of nurse examiners.
Training and Experience: Worker receives in-service training in special
areas.
Job Knowledge: Good knowledge of general nursing theory and practice,
including those basic knowledges relating to nursing, such as biological,
physical, social, and medical sciences', and their application, for better
understanding of patient-care problems. Thorough knowledge of prin­
ciples, methods, and techniques involved in performing general nursing
services and adapting or modifying standard nursing practices for care
of specific cases. Familiarity with organization, function, policies,
regulations, and procedures of hospital as they relate to nursing services.
Knowledge of literature and new developments in nursing field.

Private duty nurses in hospitals, health institutions, or private
homes all perform essentially the services as described for the general
4

staff nurse, who is not specialized. The private duty nurse may have
a different working environment from the staff nurse, and may deal
with different kinds of medical care or cases; but the chief difference
is in the employer. The private duty nurse is employed by her patient
or his family, even when on duty in the hospital; whereas the staff
or general duty nurse is employed by the hospital or institution.
Regardless of whether the employer is the patient or the hospital,
however, the general professional nurse conforms to the orders of the
attending physician. When she is on private duty in a hospital, she
observes the rules and regulations of the hospital nursing service,
except that she is not on call to attend other patients.
Clinical Specialization
The first important set of job variations to be considered arises out
of the specialized fields of medicine commonly referred to as clinical
specialties. Many professional nurses, after having served in a general
duty capacity for a time, find that they have a strong interest in, or
proficiency for, some aspect of patient care and treatment which
demands special skills.
The most common clinical specializations in which professional
nurses may gain proficiency are listed:
medicine
surgery
obstetrics
gynecology
urology
pediatrics
ear,

psychiatry
' neurology
orthopedics
communicable diseases
skin
eye
■, throat

A nurse who is adept at handling complex technical equipment
and is challenged by the opportunities to use her skill and patience in
connection with surgery, may become a surgical nurse or instrument
nurse in the operating room. Another may take a great interest in
working with young children and specialize in pediatric nursing or
perhaps in maternity care.
In addition to the well established nurse specializations new ones
are in process of development and all are moving toward standardiza­
tion of requirements and qualifications.
Advanced study and experience are required for all of the special­
ized nursing positions, but the nurse’s first job assignment may be in
a special field in which she can obtain some first-hand knowledge of
the work involved. Some specializations, like that of nurse anesthe­
tist, which is often regarded as a nursing career-combination, have
comparatively high standards of training for a job which makes
rigorous demands in skill and responsibility (57). Requirements
usually include a special course of 1 year or more of study at the
college level, and standards for training and achievement in the
5

special branches of nursing are continually being reviewed and
revised by professional medical and nursing organizations.
Performance requirements and qualifications for the most common
nurse specializations in hospital work are set forth in the Department
of Labor’s job descriptions for hospitals, previously cited (57). For
more detailed information about the educational requirements, how­
ever, current standards as set forth by employers and professional
nurse organizations must be examined.
Job Variations According to Type of Employer
Employers other than private patients or hospitals account for
another set of job variations in addition to clinic specialization. The
specific duties of a nursing job may be determined by the kind of
employer for whom the job is performed, or by the special phase of
medical treatment, or both, but discussion of occupational variety in
nursing is directed at this point mainly to the type of employer. TV
work environment, the agency program, and the patients for whom
the services are performed all combine to determine the job variations.
Public health nursing jobs.—Except for hospitals, public health agen­
cies, Government and nongovernment, offer employment to the largest
number of nurses. Federal, State and local (county or city) govern­
ments employ nurses for health departments, schools, home nursing
service, public education, and specialized clinics for many kinds of
care. Private health agencies which conduct programs for families,
children, the handicapped, and the temporarily disabled, are engaged
in various phases of public health work. There are also a number of
agencies which are devoted to patient care or public education accord­
ing to a wide range of medical specializations, such as heai't disease,
cancer, venereal disease, poliomyelitis, etc. (Industrial nursing is
also designated as public health nursing but is considered separately
in this section.)
The number and kind of organizations in the public health field
provide for an infinite variety of job duties for the professional nurse.
Clinical specialization and work environment are basic factors in de­
termining the character of the nurse job. For example, if a nurse
chooses to work for an agency concerned with infant care, she will
not only do specialized work with infants and mothers but, according
to the particular agency’s program, she may also have a choice of
work location; she may be assigned to a district clinic where mothers
bring their babies, or to visit the homes of patients, or a combination
of these job settings. In another kind of health agency, the nurse may
be required to perform such diverse duties as demonstrate diet plans
to groups of patients, or help to prepare charts and booklets on home
health and sanitation problems. In some States she may work for a
public health department which will send her out to extend nursing
6

Visiting nurse in the
home.

Nurse in Indian Serv­
ice clinic demon­
stration.

Staff nurse in the
hospital.

Figure 2.—Mothers learn from specially trained nurses how to care for
their children.
care and provide information about disease prevention to families of
immigrant harvesters. In still other public health jobs, the nurse
may serve on a special medical team with a physician, a social worker,
a technical specialist, and an occupational therapist if she is em­
ployed by a rehabilitation agency serving physically disabled per7

sons. Work settings and relationships with fellow employees and
patients are important in their effect on the character of a specific
job.
One highly specialized branch of public health nursing is nursemidwifery, for which the graduate nurse is required to take an
advanced course in obstetrical nursing, combining intensive classroom
and laboratory work with opportunities for supervised practice for
a period of a year or more. Such courses are usually conducted by
professional nursing organizations like the Maternity Center Associa­
tion in New York City (J/8) or the Frontier Nursing Service in
Kentucky, and provide for college level study combined with practical
experience. With the shortage of physicians both in crowded urban
districts and in remote rural areas of this country, the skilled nursemidwife supervises and teaches the untrained, self-designated mid­
wives and is on call to attend mothers for whom there would otherwise
be no proper obstetrical care.
There are, however, some basic differences between the nursemidwife job in a rural mountain area and in a large city. The work
environment determines the character of the patient group and the
size of the “case load”; and the methods of transportation to work
differ from, say, riding in the subway in Manhattan to driving a horse
and buggy or an automobile (or perhaps flying in a helicopter) in the
mountainous country.
With increased training and experience, the public health nurse
may extend her career into promotional and executive fields where
she will use her first-hand knowledge of nursing for public education,
community relations and broad service to her profession rather than
in direct nursing service. Opportunities here are unlimited and go
far beyond the registered nurse training, combining a depth and
variety of special skills and personal traits for which no particular
job standards or course of study may be set.
Actually the first great nurses were, in a sense, public health nurses.
Elizabeth Fry, who preceded Florence Nightingale with the founding
of a nursing organization in England, spent much of her life working
for prison and institutional reform; and Miss Nightingale herself,
who is remembered traditionally as carrying a lamp to wounded
soldiers in the darkness and despair of a barracks hospital during the
Crimean War, actually spent most of her 90 years in projects devoted
to public health improvement in the broadest sense, including the
organization of a school of nursing (26).
Nurse occupations in Federal civilian service.—Because the Federal
Government is the largest single employer of nurses, both civilian and
military, and conducts a wide range of programs in the public in­
terest, the job possibilities in Government service are multitudinous.
Civilian nursing positions are in the public health field, in hospitals,
8

in the Veterans’ Administration, in such special agencies as the
Children's Bureau in the Department of Health. Education and Wel­
fare, and the Office of Indian Affairs in the Department of the Interior,
and even in foreign service for the Department of State. The variety
of jobs covers almost the entire nursing career field, from bedside care
in American hospitals or first aid treatment for Indians or Eskimos in a
clinic, to consultation service on child health and administration of
hospital nursing programs.
Most Federal civilian nurses are employed in accordance with
United States Civil Service regulations, but there is a special group
of nurses in the Public Health Service known as the Commissioned
Corps. Although civilian employees in the sense that they serve in
civilian, rather than in military-connected posts, Commissioned Corps
Nurses receive rank and salary comparable to those for Army, Navy,
and Air Force nurses, and are on 24-hour call. They may wear uni­
forms occasionally, under special circumstances, but ordinarily wear
the nurse civilian dress.
Minimum requirements for beginning Federal civil service posi­
tions in a number of categories are given in the appendix.
Military nurse occupations.—All military women nurses in the three
branches of service which employ them are commissioned nurse officers
organized in a special corps for each service branch, except for some
temporary employees who are hired under civil service procedure.
(Men nurses in the Armed Forces are limited to nonofficer ratings,
although professional nursing organizations have supported measures
to establish ratings for male nurses.) In the mid-nineteenth century
women who wished to become army nurses had either to enter a reli­
gious nursing order or run the risk of being considered eccentric and
acting with impropriety. Some women who became military nurses
in the early years were not characterized by good reputations and
high nursing standards, so that the pioneer professional nurses in this
field sometimes suffered because of the conduct of their colleagues.
Today’s military nurse requirements are high, and opportunities
for service, advancement, and specialized training are extensive in
the Ai'med Forces.
The United States Army Nurse Corps, oldest of the women’s mili­
tary services, is an all-commissioned corps, consisting of regular Army
nurses, reserve nurses on extended active duty and reserve nurses in
civilian practice. All appointees must be high-school graduates,
registered nurses, and graduates of nursing schools acceptable to the
Army. Nurses with no experience begin at the grade of second lieu­
tenant, and are appointed to successively higher grades, with experi­
ence, up to and including lieutenant colonel; the chief of the nurse
corps is ranked as full colonel.
249599—53------ 3

9

A nurse entering Army service is first appointed in the Organized
Reserve Corps after which she may either receive a regular Army
appointment or be assigned to extended duty in the Reserve.
Army nurses are grouped in three broad classes of occupations:
general duty nurses; clinical specialists including pediatric, com­
municable disease, and Army health nurses (similar to public health
work); and nurse administrators. The general training goal of the
Army is to assign all of its nursing staff first to positions in bedside
care and then to provide specialized training in some phase of nursing.
Instruction is available for Reserve Corps nurses on extended active
duty, as well as for regular commissioned nurses, in specialized fields
such as anesthesiology, operating room technique and management,
neuropsychiatric nursing, and nursing administration. University
training which leads toward an academic degree is available for a
selected number of regular Army nurses each year. With university
training the Army nurse may obtain a key post as an administrator
or teacher.
For Navy and Air Force nurses regulations governing appoint­
ment, rank, and opportunities for advancement are comparable to
those of the Army Nurse Corps. The age range for reserve commis­
sions in the Navy Nurse Corps is 21 to 40 years, and in both Army and

Flight nurse super­
vises loading soldier
patient on Air Force
Transport plane.

Teamwork in an
Army operating
room.

Figure 3.—Nursing specialties in the Armed Forces.
10

Air Force, 21 to 45 years. All of the services require citizenship; but
the Navy requires that the candidate be naturalized for 10 years or
more if not native born. For the three services, nurse candidates may
be either married or single, but may not have dependents under 18
years of age.
Navy Nurses may be assigned to any one of 22 hospitals within the
continental United States in peacetime; and in emergency to hospital
ships, sea or air transports, and air ambulance or litter service. Their
patients are men or women of the Navy or their families. Most of
the nurse positions involve direct bedside care; in addition, there are
jobs involving the instruction of hospital corpsmen and posts requir­
ing supervision and training of nurses, and ward and clinic super­
vision. The Navy Nurse Corps commissions officers from ensign up
to and including captain.
Air Force Nurses are assigned as general duty nurses, nurse admin­
istrators, nurse anesthetists, operating room nurses, and psychiatric
nurses. Each year a limited number of Air Force nurses are selected
and sent to leading military and civilian establishments for postgrad­
uate nurse training in the specialized medical fields, as well as in teach­
ing and administrative work. An Air Force specialty is flight nurse,
for which training is given at the only school of its kind, the school of
Aviation Medicine at Gunter Air Force Base, Montgomery, Ala.
Here, the techniques of bedside care under flight conditions are taught.
Air Force nurses may serve in the United States or in posts in 15 or
more foreign countries, and requests for location preference are
fulfilled to the greatest possible extent.
Industrial nursing jobs.—Most large industrial and business organ­
izations today have a medical or health division for their employees.
Nurses employed in such a division are known as industrial nurses.
Industrial nurses may work in one of a considerable range of job
locations: factories, hotels, retail stores, ships, overseas airlines, banks,
insurance companies, and even on rubber or sugar plantations. The
work environment determines, to a great extent, the specific kinds of
experience that the industrial nurse acquires.
The industrial nurse often works alone and is not under constant
medical direction. The nurse does not supplant the physician but
rather supplements his services. In plants depending upon a physi­
cian “on call,” the nurse may be required to take medical action before
a physician’s diagnosis is made. To guide her in such emergencies, the
physician prepares general instructions which are usually called
standing orders and are applicable to the specific requirements of the
plant. These directions cover first-aid procedures and palliative meas­
ures to afford symptomatic relief in emergencies. Absence of sound
procedures for use in emergencies may result in serious difficulties for
the nurse or in legal action against the industrial plant.
11

In Federal and State Governments, the employee health services
usually operate as a unit of a public health department and the nursing
jobs are usually classified as public health service.
One of the chief concerns of the nurse in a large industrial plant is
accident and sickness prevention. Her daily or weekly inspection
tours are an important function, during which sanitation and accident
hazards are noted. She is usually a member of the safety committee
and her records are a source file for action. These include daily
records, individual medical records, disability absentee records, com­
pensation records, and monthly and annual reports, all of which are
useful aids in planning for decreasing absences and increasing effi­
ciency. She may make charts comparing the statistics of her company
with countrywide data. In cases where an unusual number of acci­
dents occur to an individual employee, the nurse may make a study
to determine the cause—emotional stress, actual job hazard, or in­
capacity for the job. She may use individual and group instruction
and show films during working hours to teach such subjects as safety,
general health, food handling, or nutrition. She may do home visit­
ing of the ill or injured employee, to help shorten his period of dis­
ability by making suggestions on nursing care to responsible family
members or by referral to community sources for assistance.
The industrial nurse works closely with the personnel department
regarding proper placements, and examination of employees return­
ing after illness or accident. This is a challenging type of work for a
woman attracted both to nursing and business and requires a variety
of duties and an interest in the personnel and health education fields,
as well as in nursing.
Office nurses.—Another large group of employers are physicians and
dentists in private practice who require nurses in attendance at their
consultation offices or small private clinics. In 1949 almost 9 percent
of all working professional nurses were employed as office nurses,
working for one or more physicians or dentists in the same office.
In the doctor’s office the nurse assists with physical examinations,
with administering treatments, sterilizing instruments, and giving
medication. In a small office she may also schedule appointments
and prepare records and reports. Sometimes she may “double” as a
laboratory technician, for which special training is required in such
duties as making blood counts or preparing microscopic slides for
bacteria examination. She may help the physician by discussing medi­
cation and treatment instructions with patients, upon his direction.
If the physician or group of physicians specializes in any branch of
medical practice, the nurse will also have an opportunity for special­
ized nursing work. Usually, the large offices, where several doctors
combine their business quarters, employ a secretary-receptionist, and
12

perhaps even a laboratory technician, in addition to one or more
nurses. In the small office the nurse is apt to have a great variety
of job duties, including a considerable amount of clerical or secre­
tarial work.
Nurse Instructors
Full-time nurse instructors are specialists in education in addition
to being professional nurses. They are needed to teach many courses
such as nursing techniques and nursing ethics and other subjects which
involve the application of a number of sciences and arts to nursing
service.
Nursing schools depend extensively upon experienced hospital
nurses to provide on-the-job instruction for students as a regular part
of the job, or as lecturers on specific topics to student groups. Nurses
who teach on this part-time and periodic basis are known by their
regular job titles and are not considered instructors in nursing
education.
Beginning jobs in nursing education usually require about 5 years
of college training or education equivalent to a master’s degree in
addition to experience as a professional nurse. The National League
for Nursing maintains current information about faculty positions
in schools of nursing and the preparation required for nurses who
wish to enter this career field.
Nurse Examiners on State Boards
Closely related in job knowledge and general preparation to work
in the field of nursing education are the executive secretary positions
on State boards of nurse examiners. The functions of such Boards
deal mainly with administration of the State nursing practice laws
and regulations, and involve the establishment of standards for the
operation and curricula of accredited schools of nursing and the exami­
nation and eligibility determinations of nurses who are candidates
for licensure and registration. There are relatively few executive
positions for nurses on examining boards, and nurse examiners who
are not executive secretaries serve on a part-time basis in many States.
Administrative Nursing Positions
Administrative positions are found in every occupational division
of nursing service and nursing education. Some discussion of higher
level positions in nursing will be found in Section II, under opportu­
nities for career advancement.
Job Combinations With Nursing
The professional nurse may take her basic training into a career
field that provides a combination of job duties. She may become a
13

Placement Counselor in a nurse registry, a school, or employment

office and help other nurses to find appropriate jobs. She may go into
professional organization work and obtain a full-time position with
an organization like the American Nurses’ Association, National
League for Nursing, or the American Association of Industrial Nurses,
or become an executive of a State or district (local) nurses’ association,
and specialize in public relations, research, administrative work, or
fund raising and membership promotion.
If she is interested in a writing career the nurse may go into
Editorial work for a professional, commercial, or research publica­
tion in the nursing field.
Some business organizations employ nurses as Consultants in the

manufacture and distribution of medical or surgical products.
Nurse Technician jobs combine the professional nurse occupation
with the medical technician occupation for which special laboratory
techniques and a knowledge of scientific equipment are used. Most
nurse technician jobs are in cardiology, basal metabolism, X-ray
therapy, and electroencephalography.
Jobs like that of nurse anesthetist and nurse midwife are often
regarded as career combinations but they have been treated in this
description of the occupational field along with clinical specializations
(see page 5).
These are only a few of the possible job combinations which are
based upon professional nurse training; many new career combina­
tions are being established by nurses who, themselves, create unique
positions.
Opportunities for Nurses in Foreign Service
Because of the extension of our country’s interests to many parts of
the world, employment opportunities abroad have increased in all
fields, including nursing. Not so many years ago, the nurse who
wished to work abroad was limited in job opportunities to religious
field work with the various church missions, or to military service. To­
day, the World Health Organization, affiliated with the United Na­
tions, has added public health nurses to almost all of its field teams.
The Foreign Service of the State Department employs nurses in its
embassies and missions, and many business and industrial organiza­
tions need nurses for their field establishments in foreign countries.
For most foreign service jobs a nurse must be single and free from
home responsibilities, although some married nurses who accompany
their husbands in civilian jobs may obtain employment abroad. The
kinds of jobs available do not differ essentially from the general range
described briefly for employment in the United States, except for the
setting and the challenges afforded by working in a different culture.
14

II.—THE OUTLOOK

The Demand for More Nurse Recruits
Young women considering a choice of careers will be interested to
know that the number of job openings for years to come will probably
be better for nurses than for almost any other occupation traditionally
undertaken by women and requiring career training. There will not
only be job opportunities, but many avenues of advancement in the
field of professional nursing. The extent to which the individual
nurse can increase her proficiency and skills and fulfill her career
goals will depend largely upon her own interests in, and efforts toward,
advancing her professional status.
The demand for nurses is immediate and urgent and also promises
to be prolonged for at least another decade. It grows out of the
expansion of medical and health services which have not only en­
larged their existing facilities, but which have also extended their
scope and variety, through medical discoveries, to create new types
of nursing activity. It is a result also of a population expanding in
numbers and a population which has steadily advanced its life ex­
pectancy, thus creating a need for additional health services both
among the very young and the aging. The number of disabled vet­
erans from World War II and the continuing return of ill and
wounded American soldiers from the Korean conflict also affect the
demand for nurses: An increasing proportion of battle casualties are
being restored by new treatment and nursing methods both at battlefront stations and at home.
Although the current number of students enrolled in nursing schools
exceeds all records, the ratio of nurse students to the population re­
mains at approximately the same level as it has been for some years,
except for the period of the nurse recruitment drive during World
War II when Federal funds were available for educational purposes.
In the years 1943 to 1945, 9.5 percent of the young women graduated
from high school entered nurse training. The 1951 ratio was about
6.7 percent, according to information from the United States Office
of Education.
The largest class in 5 years was admitted to the schools of nursing
throughout the Nation in 1950 (44,185 first-year students, an increase
of 1.3 percent over the previous year). The heaviest enrollment was
in the populous States of New York, Pennsylvania, Illinois, and
Massachusetts. The largest percentage increases over 1949 were in
Mississippi and Louisiana—28 and 53 percent, respectively. How­
ever, while 22 States had increases, reductions of 15 percent or more
were reported in the District of Columbia, South Carolina, Montana,
Arkansas, and Arizona (50). Many nursing schools were unable to
recruit enough applicants to fill their classes in 1950.
15

Some disagreement exists as to the extent and probable duration of
the nurse shortage, but all authorities are in agreement that the present
and anticipated shortage in supply of nurses is critical, and that it
affects the Nation’s health and welfare. Possible reductions in the
estimated demand for nurses involve primarily the question of effective
utilization of all classes of nursing personnel, and utilization, in turn,
involves several broad and complex questions related to established
medical, hospital, and nurse educational practices. Estimates on
nurse demand, which follow, are therefore presented without reference
to factors which may change the demand picture to some extent when
more exact and complete information about them is available.
Estimates for Nursepower
In 1947 the President’s Commission on Higher Education predicted
that over 500,000 nurses would be needed by 1960 (a 40-percent in­
crease, based on the current number of nurses). The Health Resources
Advisory Committee of the National Security Resources Board esti­
mated that the number of active professional nurses required to
maintain the 1949 ratio of nurses to the population in 1954 would be
404,500; but at the present rate of increase the Nation would be short
of meeting even this ratio by some 49,000 nurses in 1954.
The Joint Committee on Nursing in National Security estimated
that 381,886 graduate nurses were needed to meet minimum civilian
nursing needs in 1950 but that only 316,500 nurses were actually en­
gaged in giving service to civilians at the end of the year.1 Estimates
of need, both civilian and military, made by the TJ. S. Public Health
Service, were as high as 100,000 additional nurses for 1950. Only
25,790 new nurses were graduated in that year, according to the Na­
tional League for Nursing; this is less than half the number needed
to fill existing vacancies (6, p. 18).
Most Critical Areas of Nurse Shortage
Hospitals, which have been steadily expanding their facilities for
over four decades, began to suffer seriously from the effects of the
nurse shortage in the 1940’s, and some of the smaller ones, in com­
petition writh those able to pay more attractive salaries, were forced
to close. In 1910 the nurse-population ratio had been 1 professional
nurse for 1,116 persons, but this was increased to a minimum of
1 nurse for 316 persons by 1946 (5).
In 1951, the American Hospital Association stated that 22,486
vacancies for graduate nurses existed in 2,677 of the 4,830 hospitals
which reported on the nurse shortage (3).
1 The decennial census classified 393,519 women in the labor force as professional nurses,
of whom 388,511 were employed or self-employed in April 1950. In addition, there were
75,064 women listed as student professional nurses, of whom 74,574 were employed.

16

The nursing situation in a metropolitan area in the East in 1951
is typical of the profession countrywide. One large hospital re­
ported 41 beds closed for lack of nurses. Another was experiencing
difficulty in finding nurses to staff a new 125-bed addition to the
hospital which was urgently needed to be placed in service. Four
other hospitals reported a combined shortage of about 100 nurses.
Part-time nurses were being hired by one of the hospitals in an
attempt to meet the emergency. These were private hospitals, un­
able to compete with salary scales of other hospitals in the area.
To fill existing vacancies in this city and bring its services up to
minimum standards it was estimated that 855 more graduate nurses
were needed to supplement the 3,838 employed in 1952. An earlier
report indicated that 1,172 inactive graduate nurses lived in the
area in 1949 but apparently their availability was doubtful. Out of
410 of these inactive nurses in 1950, 30 were found disabled or em­
ployed in another field and 206 unavailable because of family re­
sponsibilities. However, 174 indicated that, although they were
inactive at the time of the study, they would be available for work
in case of an emergency. The New York State Employment Service
reported an average of 500 to 600 openings for private duty nurses
unfilled each month because nurses are not available for designated
locations and hours.
Only an estimated 175, or 4 percent of the 4,530 girls graduated
from high school in this area, entered schools of nursing in 1950,
as compared with an average of 7 percent for the entire country.
Of all students admitted to the schools of nursing in the area in 1952,
however, 179 or 32 percent came from the area itself while 386 girls
or the remaining 68 percent came from outside the area. No infor­
mation was available of the number of area girls who went elsewhere
to train for nursing (£5).
A southwestern city reported that because of the scarcity of gradu­
ate nurses one hospital was unable to open a new wing until additional
nurses became available.
Public health nursing is important in spreading available nursing
services among the population to the best advantage. It is also
useful in relieving the pressure in hospitals. Health authorities
recognize the significant role that public health nurses play in carry­
ing into practice almost every phase of medical and health protection,
especially with respect to disease prevention through educational
methods. With these important considerations in view, it is esti­
mated that public health nursing services need to double the number
of professional nurses now employed in order to meet minimum
requirements; for complete nursing programs, three times the present
number of nurses would be required.
249599—53

4

17

i

Figure 4.—A public health nurse presents community education plans to
agency representatives.
Almost two-thirds of the States still have some counties without full­
time public health nursing service for the rural population. Every
year several of the States report that they have funds available to hire
more nurses than they can obtain. The distribution of public health
nurses in relation to population shows much variation, ranging from
one nurse to 3,000 persons in some States to one to 15,000 in others (68).
The total number of public health nurses employed in the United
States as of January 1, 1950, was 25,081. This was an increase of
1,708 compared with 1949 and 4,409 compared with 1946 (27).
Administrative nurses and nurse instructors in adequate numbers
are required to bridge the gaps between health program planning
and execution, and between nurse preparation and nurse service.
The fact that most administrative and supervisory nurses in hospitals
and institutions of all kinds are responsible for continuing the edu­
cation of graduate nurses through in-service training and development
places them appropriately with the teaching nurse group. College
preparation, in addition to nurse training, is essential for supervisory
and educational nurses. A 1951 estimate by the National Security
Eesources Board (30) indicates that by 1960, 140,000 nurses with the
bachelor’s degree will be needed for administrative, supervisory, and
instructors’ positions. At the current rate of about 4,000 a year
graduated from degree courses, there would be some 30,000 new degree
graduates by 1960—a number far short of the need.
18

Among Federal agencies, the greatest number of openings for nurses
is in the Army commissioned corps, following upon an expansion
of Army hospital facilities beginning in June 1950 with the Korean
conflict. The Army reported over 120 vacancies in its hospitals
early in 1952 and a need for possibly 2,000 additional nurses to staff
new hospitals.
The Navy Nurse Corps was planning in 1952 to recruit 1,000 ad­
ditional nurses and the Air Force 1,200 to 1,500.
Although the Veterans’ Administration has been able to meet the
turnover in general staff nurses, specialized nursing personnel for
neurological, psychiatric, and tuberculosis patients are needed. Nurses
who are not specialists in these fields are accepted and given in-service
training to make them proficient in these types of nursing.
The Bureau of Indian Affairs reported 153 vacancies in its hospitals
in 1952. This included 5 directors of nursing, 4 assistant directors, 4
instructors, and 10 head nurses in addition to staff nurses. The most
acute shortage existed in Oklahoma, Washington State, Arizona, and
Alaska. A large modern tuberculosis hospital being erected in An­
chorage, Alaska, will need a complete staff of nurses.
Industrial nurses are needed in greater number to fill the vacancies
existing and the new positions which are being created in the expansion
of health services for employed groups. In a midwestern State, a
survey indicated that industrial nursing services reached only about
15 percent of nonagricultural employees. For white collar workers,
in this particular State, the service was available to less than 8 percent
(37). Because many places of work are too small for a full-time in­
dustrial nurse, the use of part-time medical and nursing services
presents a feasible solution.
Psychiatric nursing is a growing field in which the professional
nurse can make significant contributions and for which qualified nurses
are needed more urgently with each extension of the services in the
mental health field. Modern health treatment calls for a wider accep­
tance of psychological and psychiatric principles in almost every kind
of therapy. While the relief of epidemics and the treatment of many
physical ailments have become assured on the whole, the preventive
and the mental health problems of medicine present new challenges.
Nursing instructors point out that nurses need instruction in the
latter field because a high proportion of all hospital patients have men­
tal illnesses or mental and physical illnesses combined. However, only
a small percentage of all staff nurses specialize in psychiatric nursing.
By the end of World War II the shortage of psychiatric nurses
was generally recognized. Many hospitals with 2,000 to 10,000 mental
patients had only one psychiatric nurse. The countrywide shortage
of psychiatric nurses was estimated to be 41,000 at the end of 1946,
and the situation has not improved since.
19

There is, in summary, an urgent demand not only for specially
trained psychiatric nurses, but also for well-rounded training of all
nurses in the emotional aspects of illness.
The Quality Shortage
Indeed, the entire problem of the nurse shortage is one of quality as
well as quantity. General duty nurses today need to know a great
deal more than the old-style hospital school provided in the way of
training. Developments in the psychosomatic aspects of illness (deal­
ing with the relationships between the mental and the physical condi­
tions of a patient), in treatment through the use of newly discovered
drugs of all kinds, in new methods of surgical practice require that
the nurse who completed her initial training 10—even 5—years ago,
must work hard to keep up with today’s demands, or she is not likely
to be employed, for some types of jobs, as readily as the young gradu­
ate. On the other hand, this year’s candidate for nursing school must
give special thought to the right choice of school in relation to her
career because many more nurse jobs each year require college training
and even advanced degrees.
Some professional nursing authorities are considerably alarmed at
the quality shortage among professional nurses. A recent published
statement about nursing states that many so-called “specialized” nurses
are no more than amateurs in their field (J/J). About one-fifth of the
nurses serving in psychiatric institutions have no special training in
the treatment of mental illness. More than a third of all public health
nurses have received no formal instruction in their specialty. Prob­
ably three-fifths of the nursing administrators and supervisors in
hospitals, and teachers in schools of nursing have had to acquire
through practical experience the special knowledge and skills they
need.
There is no doubt that improvement in the quality, as well as in­
crease in the quantity, of nursepower will depend very heavily upon
the key provision of appropriately trained nurse teachers, admin­
istrators, and supervisors to promote a general raising of the educa­
tional standards for all nurses in training. This means not only
that the outlook for college-trained nurses is promising, but that
nurse candidates in the coming years will be urged, through an in­
creasing number of recruitment and counseling channels, to study
in collegiate schools of nursing.
Factors Affecting the Nurse Shortage
A number of factors contribute to the current and anticipated
nurse shortage. Some are the result of changes in both the character
and count of the population, and others relate to economic and social
trends. A situation in which the general supply of young women
20

workers is short, because of a real population shortage in certain age
groups, and also because of an increased number of marriages, affects
the supply of nurse candidates as much as it does any of the occupa­
tions traditionally undertaken by young women.2
Shortage of young women in the population.—The number of young
girls available in the present decade for career training of all kinds
is less than in former years because the high-school graduates of
the 1950’s were born in the depression period when the Nation’s birth
rate was at its lowest ebb since 1910. In 1940 the number of women
15 to 19 years old in the population was 6,153,370, but in 1950 the
number was only 5,431,000. According to decennial census figures,
in 1950 there were about 300,000 fewer women 18 and 19 years of
age than in 1940.3 Not until 1960 will the declining trend in the
number of young women in the population be reversed. Meanwhile,
the general population increased in the decade 1940 to 1950 among
the youngest and the oldest age groups.
Increase among young women with home responsibilities.—In 1950,
54 percent of all women 18 to 24 years of age were married (with
husbands present), compared with 39.8 percent in 1940. The birth
rate per 1,000 female population 15 to 19 increased from 48.9 in 1940
to 79.7 in 1948, and the number of children under 5 years of age in­
creased by 54.7 percent from 1940 to 1950.3
The increase in the number of marriages among young women is
reflected in the withdrawal rate of nurses, which is estimated at 6.5
percent a year (30).
Nurse salaries and cost of education.—In the full employment period
which has characterized the national economy since the outbreak of
the Korean conflict, a number of young women who might otherwise
enter career training for occupations like nursing, teaching and social
work are able readily to obtain attractive jobs in business and in­
dustry, without the sacrifices that long training periods demand.
Office and factory employment are not bound to the traditional salary
approaches of many of the white-collar professional and semiprofes­
sional jobs, and show more fluctuation to correspond with economic
changes. When jobs without long-term training are plentiful in
the labor market and educational costs for career jobs tend to increase
along with other costs of living, all of the occupations which have not
kept pace with commerce and industry with respect to economic re­
wards tend to suffer from a lack of recruits.
From a short-term point of view it cannot be denied that the pro­
fessional nursing occupations fail to offer the relative attractions in
salary and immediate rewards that many office and factory jobs pro2 “The Shortage of Young Women Workers.”
3 Ibid.

Women’s Bureau Leaflet 15. 1953.

21

vide. The candidate for nurse training today bases her choice upon
other considerations relating to long-term career satisfactions; also
upon the reasonable expectancy that a new trend in nurse education
and nurse job opportunities may bring the corresponding economic
rewards.
To encourage young women to enter nurse training, and to assist
those for whom the financial sacrifice Aould be a deterrent, Representa­
tive Frances P. Bolton introduced a bill (H. R. 910) into the 82d
Congress in January 1951 for aid to nursing education. The bill was
tabled by the Committee on Interstate and Foreign Commerce in
March 1952. A similar bill was introduced into the Senate (S. 2301)
on October 18,1951, by Senator Ives, but it was held in the Committee
on Labor and Public Welfare in mid-1952 and died there when the
Congress adjourned. Mrs. Bolton offered another bill in June 1952,
but it, too, died in committee.
In the 83d Congress bills of this type were introduced by Representa­
tives Bolton (H. R. 3850) and Dingell (H. R. 1817). Mrs. Bolton’s
bill, introduced on March 10, 1953, would authorize limited grants of
United States funds to States to assist schools of nursing in meeting
the increased costs of instruction and to provide scholarships for nurs­
ing students in both the registered and the practical nurse fields. The
sums to be appropriated are limited to $5,000,000 the first year, $10,­
000,000 the second, and $15,000,000 the third. The Dingell bill also
sought to increase the number of adequately trained professional and
other health personnel, including nurses, by providing financial aid
for their education.
The question of nurse salaries is more fully treated in a subsequent
chapter on conditions of employment.
Educational trends.—-Probably no other occupation is undergoing
educational change at present to the same extent as nursing because
of the great demands now being placed on the professional nurse. (See
Section IV on Training for a Nurse Career.) In general, professional
nurse training is moving toward higher professional requirements and
away from the apprentice-like period of service which has been char­
acteristic of hospital-school courses from the 1870’s. Because of this
trend, there are very wide variations in what the several kinds of
educational facilities offer. Until nurse training programs become
more standardized in accordance with new career objectives, there will
doubtless be problems which affect the supply of graduate nurses each
year, both as to quantity and quality.
One of the problems of nurse education is created by the number of
withdrawals from nursing schools. About one-third of the nurse
students entering training fail to finish the course (16). It has been
reported that the withdrawal rate is sometimes as high as 39 percent,
22

and that more leave before graduation because of failure in class work
[Jf5) than because of other reasons, such as early marriage.
Many studies suggest that poor selection of nurse candidates is one
of the chief causes of drop-outs early in the training period, and that
attrition could be reduced appreciably by better methods of screening.
Such methods include the use of aptitude tests and placement inter­
views.
Measures to increase the number of recruits for the nursing career
must take into account the availability of training facilities which can
meet today’s professional standards. Careful study of this problem,
and of the variations in general of the nurse education program, may
point to the necessity for immediate and large-scale reforms, encour­
aged by community subsidy, for nurse training institutions, and for
scholarships for nurse trainees who cannot meet educational costs.
The larger institutions are better able than are the small hospital
schools to provide a well-qualified faculty, a wide range of clinical
experience, and opportunities for diagnostic study.
In all plans which concern the problem of nurse education, the grad­
uate as well as the recruit should be provided for in the total program.
Today’s practicing registered nurse may be a good candidate for
career advancement with the appropriate additional training. How­
ever, many who would like advanced training find that their employers
are reluctant to release them during the nursing shortage, or that
costs are prohibitive. Moreover, it may be difficult to obtain the
courses they want, as the bachelor of science in nursing is not always
recognized by universities and colleges when its holders apply for
admission as candidates for the master’s degree (Jfi).
Utilization of professional nursing personnel.—During World War
II the nurse shortage focused attention as never before on the im­
portance of making the most effective use and distribution of nursing
personnel in the Nation’s interest. Among the measures taken to
spread professional nursing services as widely as possible was the re­
organization of the nurse’s j ob in many hospitals and institutions. For
some time before the war emergency it had been noted by many per­
sons concerned with hospital and clinic administration that the nurse’s
time on duty was not always used to take the best advantage of her
training and skill: Perhaps as much as half of a staff nurse’s assign­
ments, and more in many cases, consisted of tasks that could easily be
performed by practical nurses, nurse aides, and clerks. In the wartime
crisis a number of institution and agency staffs began to experiment
with job breakdowns among nurses and auxiliary workers which would
free the professional nurse for assignments commensurate with her
training and ability. Administratively progressive agencies have
continued, ever since, to study the nursing function and make the
23

Figure 5.—Navy nurse instructs medical corpsman in care of patient on
hospital ship.
appropriate reorganizations. Out of this movement many new ap­
plications of the team idea in nursing have been made.
The nursing team provides for a professional nurse in a supervisory
relationship to one or more practical nurses and nurse aides, and the
team as a whole is assigned to a specific unit of the agency. Depending
upon the size and complexity of the institution, the nurse in charge
of a team may report to a head floor nurse, a head nurse in charge of
several wards, or to the nurse administering the hospital. There are
many possible variations of the team idea and a number of professional
groups have already made studies and recommendations on it, as well
as upon the nursing function in other kinds of jobs.
Whether a nursing-team plan is applied generally to staff nursing
practices or not, there is no doubt that the current interest in the nurs­
ing function will eventually produce changes in the pattern of nurse
occupations for effective utilization of personnel.
In 1950 the American Nurses’ Association began a program of study
of the nursing function by gathering all possible information from
existing reports, stimulating new research, and enlisting the cooper­
ation of its total membership toward research along these lines.
American Nurses’ Association members have been asked to initiate
studies of the nursing function under recognized research authorities
in their own communities, and the national office has assisted local
groups through research funds for this purpose where they were
needed.
24

A preliminary report in March 1952 of a nursing function study
that was conducted at Harper Hospital, Detroit, indicated that pro­
fessional nurses, practical nurses, nurse aides, and clerical workers
could be organized in a team relationship to provide better nursing
care at less cost than when personnel was used in the traditional ways
in the hospital. One of the premises of the study was that “no plan
[i. e., of staffing pattern] can be tailor-made to fit all institutions,”
for the study group found that variations were necessary even within
the hospital for different patterns according to the type of unit
studied (73).
In 1917 the American Medical Association appointed a committee to
study nursing problems in the United States, and its 1948 report rec­
ommended that all nurses be divided into two large groups designated
as clinical and collegiate. The chief function of the college trained
nurse was to be nursing education, and the clinical nurse would provide
nursing care and service similar to that of the present hospital trained
nurse. Some speculation concerning the possible ratios of the several
kinds of nursing personnel was made by committee members, but no
definite conclusions were reached. The AMA committee clearly
pointed out, however, that the answer to both the nursing shortage
and the need for improvement in nursing care was in teamwork, “with
the team made up of physicians, professional nurses, trained practical
nurses and subsidiary workers” (38). In the following year, a much
broader committee, consisting of 18 members equally representing
national nursing organizations, hospital administrators, and the AMA,
began an intensive study of many questions raised by the earlier report.
Known as the Joint Committee for Improvement of Care of the Pa­
tient, this group began to make preliminary reports of its findings
relating to the nursing function in medical and nursing journals
by 1953.
The Public Health Service published a monograph in 1950 on the
results of a study, conducted under the direction of the chief of the
Division of Nursing Resources, of head nurse activities in five units
in a large hospital. This study showed that although “the head nurse’s
time was spent preponderantly on activities generally accepted as those
that should be performed by a head nurse” and management duties
were relegated to second place in favor of direct nursing service, 50
percent of the time spent in management duties was reassignable to
clerical personnel; and that many of the head nurse’s duties in patient
care could have been performed by nonprofessional nursing workers.
Activities that could not be reassigned include planning and super­
vising patient care, giving or supervising patient and family educa­
tion, and personnel administration (67).
Other studies of the nursing function are bringing to light signifi­
cant facts about the under-utilization of professional nurses and also
249599—53-------5

25

about traditions and attitudes toward utilization which have consti­
tuted barriers against making changes in the nursing function. It
can be readily seen that attempts to introduce changes and reassign­
ments which affect established practices among the Nation’s nursing
personnel of all occupational levels and among countless hospitals,
institutions, and agencies not only meet resistance in the form of
crystallized attitudes but encounter some very basic problems. Wide
reorganization of the nursing function involves almost every aspect
of nursing occupations and nursing services: agency administration,
nurse training, standards for nurse jobs, both for professional and
practical nurses (and the attendant problems of wages, promotions,
hours, conditions of work), and of course the questions of costs and
standards of nursing service to the public.
Nevertheless, in the face of the critical nursing shortage, the allimportant single fact which most of the nurse function studies have
produced to date is: Demand estimates for professional nurses can
be reduced appreciably by making more effective use of the working
time of professional nurses. Some studies have indicated that job
reassignment could result in a 20-percent reduction in the estimated
demand for professional nursing personnel. All estimates tend to
indicate that proper job assignments could improve the standard of
nursing service, even with fewer professional nurses in relation to a
larger proportion of other kinds of nursing personnel (73).
Opportunities for Career Advancement
With the very considerable changes that are taking place and antici­
pated in nursing positions and nurse education, the opportunities for
advancement in nursing careers can hardly be set forth in definite pat­
terns for the next few years.
The common yardsticks to measure occupational advancement are
increases in income (salary and fringe benefits) and prestige or stand­
ing in the occupation. There is a general tendency to regard executive
or supervisory positions as the most advanced within any occupation,
and this is supported by the fact that economic rewards are corre­
spondingly higher for supervisory work at progressively more
responsible levels. This is certainly true of the nursing field. Ad­
vancement in both income and prestige are also given in most occupa­
tions for specialization that does not involve administrative or
supervisory skill, and this too applies to the nursing occupations.
Those nursing occupations which lead toward progressively greater
executive responsibility—whether with personnel, as in administra­
tive nurse jobs, or with program planning and advisory work, as in
the consultant jobs—tend to move away from direct patient-centered
care. On the other hand, jobs in specializations such as pediatrics
are essentially patient-centered. There is no doubt that economic
rewards and professional prestige are greater for the executive and
26

consultant nurses, in general, than they are for most of the clinical
specializations.
It is considered that about 25 percent of the students of each gradu­
ating class of nurses should eventually move into supervisory and
teaching posts (19). Table 1 shows that almost one-third of active
nurses in hospitals in 1951 were working in various types of executive
and teaching posts. This represents a slight trend upward over
previous estimates.
Table 1.-—Professional Nursing Personnel
Position, 1951

in

6,637 Hospitals

Type of position
Total-

N umber
_ _

Administrative _ _ _ ___ __
_ __ __ _ _ _
Full-time instructors
.
_ ... __ ..
Supervisors and assistant supervisors _
_
Head nurses and assistant head nurses
.
_
General duty nurses-___
Private duty nurses- __ _
_
_
Unclassified-- __
_

247, 854
9,
5,
22,
34,
134,
31,
7,

844
960
781
740
793
807
929

by

Type

of

Percent
100. 0
4.
2.
9.
14.
54.
12.
3.

0
4
2
0
4
8
2

Source: Journal of American Medical Association 149: 160, May 10, 1952 (12).

In hospital positions.—In the environment of the large hospitals, the
usual pattern of promotion is from general duty nurse to head nurse,
to supervisor, then to assistant director on day duty or night relief,
and to director of nursing services. Although not necessarily in direct
line of promotion, nurses in smaller hospitals are sometimes appointed
as hospital superintendents.
The head nurse usually exercises direct supervision over the general
duty nurses, manages a hospital ward, assigns personnel to the mani­
fold tasks, supervises the activities of the students, and is responsible
for supplies. The quality of the service is largely determined by her
standards and her efficiency. Head nurses usually report to a nurse
supervisor, who in turn may report to the director or assistant director
of nursing services.
The American Hospital Association made a survey of hospitals in
1951 and found that 902 hospitals or 16 percent of the 5,637 reporting
had hired chief administrative officers during the year, and 1,047 or
19.5 percent had hired head nurses (3).
In industrial positions.—Nurses can advance into supervisory work
in places of employment other than hospitals. Where an industrial
firm is large enough to require a staff of nurses, a supervisory nurse
in charge of the staff has a responsible position. Some companies
have extensive employee health services, with as many as 20 to 30
nursing personnel under the supervision of the nursing director. In
27

industry the nursing director’s job is in large part that of an instruc­
tor, as well as an executive, for she will train her staff in technique
and in company practices. She may also have charge of the mainte­
nance of the medical department and, if so, will represent the medical
director at company meetings and on committees. Salaries for nurse
directors in industry have a wide range. They are determined largely
by the prevailing salary level for the company, but are in the admin­
istrative class in large companies.
In public service.—The possibilities for advancement in Federal
service are numerous if the nurse can meet the qualifications and can
offer the desired educational preparation. As far as possible, promo­
tions made are from within the agencies. Some nurses come to the
Children’s Bureau or the U. S. Public Health Service after experience
in State or city health departments, and soon qualify for better than
beginning jobs. In military service and in the Veterans’ Administra­
tion pay raises are periodic; nurses are advanced to the next higher
grade with promotions based upon performance, qualifications, pro­
fessional background, interest in nursing, and educational preparation.
Consultants in public health.—The American Nurses’ Association
estimated that nearly 1,300 nurses were employed as consultants in
1951 (9). In the United States Public Health Service some 250 con­
sultant nurses are a part of the staff. These consultants have various
assignments, perhaps to a State health department, or a local health
department, to develop a bedside nursing program or to participate
in demonstrations in mental health, cancer, or venereal disease control.
They may work in special field studies in heart disease, nutrition, dia­
betes, or one of the communicable diseases. The Public Health Service
consultant plans and conducts in-service training programs, collects
data for various projects such as studying the efficiency of various
therapeutic drugs, and shares in the experience of new medical dis­
coveries. She may go abroad as a survey team member, director, or
staff nurse in health-education programs directed toward raising
standards in countries which need this assistance. She may participate
in mental-health institutes or industrial programs to determine new
hazards involved in the changing technology of American industry.
A consultant in a State health department may serve in a crippled
children’s agency or may develop nursing plans for children in hos­
pitals. Where home-nursing services are needed, the State consultant
may work out a field-service program, or she may improve existing
programs. A State maternity nursing consultant usually assists in
such activities as planning community programs, recruiting nurses,
establishing health study groups, advising university faculties in plan­
ning advanced courses in maternity nursing, supervising State mater­
nity-care programs, in addition to serving as consultant to hospital
staffs. Some counties and large city governments have nursing con­
28

sultants in both maternal and child care. Other consultants serve
at the request of schools of nursing for short periods to evaluate in­
struction programs, to improve personnel policies, and to introduce
new programs.
New avenues.—The nursing specializations and job combinations re­
viewed in Section I provide additional clues for the nurse who wishes
to extend her career in directions other than general duty nursing.
New avenues for specialized nursing work will continue to open with
discoveries and concepts in medical treatment and changes in nursing
education and practice. Some of the new occupational developments
for professional nurses may lead away from patient-centered care;
the great majority will be concerned directly with the care of patients.
Opportunities for Women With Special Employment Problems
Women seeking jobs sometimes encounter difficulties because of cir­
cumstances which have no specific bearing upon work proficiency, but
which are traditionally considered as limitations upon employment.
In nursing, of course, women do not find the same kinds of barriers
met in occupations traditionally filled mainly by men; nor do they
find that age is as restrictive as in many other kinds of work.
In World War II many older nurses returned to work, sometimes
after long periods of inactivity, and the older nurse has been accepted
for almost any kind of duty which her physical capacity allows her
to perform. By 1951, 4 percent of all active nurses were 60 years of
age or older, 10.9 percent were 50 to 59, and 20.1 percent were 40 to 49
years old (9). Even nurses over 70 are still in active duty, full or
part time. The Army and Air Force admit nurses up to 45 years of
age and the Navy to 40 years. The New York State Employment office
in a 2-week period in December 1952 placed 938 professional nurses,
of whom more than half were 35 or over, and nearly a third were 45
or over.
Like the older woman, the married woman became acceptable to
employers during the war and has continued to be in demand. Mar­
riage is no handicap as long as family responsibilities do not interfere
with nursing service. In 1951, 46.5 percent of active nurses were
estimated to be married in comparison with 38.7 percent single nurses
and 14.8 percent of other marital status (9). While in the past mar­
ried women were not permitted to enter schools of nursing and a
resignation was required when a nurse married, these restrictions have
been relaxed. The practice of rotation, usually followed in an institu­
tion, may be more inconvenient for a married nurse than a single nurse
but there are many jobs where day work only is required, as in
doctors’ offices, schools, or industry.
Part-time work may be possible for married nurses who are unable
to work an 8-hour day because of family demands. Usually, how­
29

ever, part-time workers with family responsibilities want to work
during the middle hours of the day only and they are often unwilling
to participate in rotation plans. This results in placing the burden
of a greater amount of undesirable evening and night work upon
full-time workers. Even with 57.7 percent of hospitals paying a
differential for evening shifts and 62.6 percent for night shifts (4)
many in the profession feel that this situation is unfair to full-time
institutional workers.
To encourage women with home responsibilities to accept nursing
positions, or return to active duty, a number of communities have tried
to find ways of assisting with housekeeping and child-care problems.
An effort which appears to have worked successfully was the estab­
lishment of day care for the young children of nurses who wished to
work at Mount Sinai Hospital in Cleveland. A nursery school was
opened in July 1951 at the hospital and has provided supervised day
care for the children of both full- and part-time nurses and other
hospital workers in critical demand {31).
Among the qualifications that affect work proficiency, physical
fitness constitutes an important job requirement for nurses, and
physical handicaps may prevent or seriously restrict employment.
Schools of nursing observe relatively rigid entrance requirements for
health and physical capacity, and physical examinations are given
periodically during the training period. The nurse who acquires disa­
bilities after training may find it difficult to obtain a job. Some schools
and some employers, however, will accept nurses with arrested tuber­
culosis or remedied orthopedic conditions and injuries which do not
interfere with specifically designated training or job requirements.
Negro women have greater opportunities in professional nursing
than ever before, even though restrictions upon their employment
and training still exist. The number of schools of nursing that admit
Negroes has quadrupled during the past few years—from 76 in 1946
to 273 in 1952. In these 273 nursing schools, 3,229 Negro students
were enrolled. Nevertheless, the number of Negro women who become
nurses is still far from adequate, as is indicated by the fact that in
1949,151 of each 10,000 white women 17 to 22 years of age were students
in schools of nursing, but only 39 per 10,000 Negro women of the same
ages {72).
The number of Negro nurses presently employed is not available be­
cause many hospitals do not indicate race on employment records. A
survey of 781 public health agencies which kept race statistics reported
768 Negro nurses in 1951, or 11.9 percent of the total staff. Of this
group, 740 were staff nurses and 28 had supervisory and administra­
tive positions (7).
Throughout the years, both the American Nurses’ Association and
the former National Organization for Public Health Nursing (now
30

the National League for Nursing) have encouraged young Negro
women to enter professional nurse training. The former supports a
program of intergroup relations to aid in opening employment and
school opportunities in this field. In 1946 the American Nurses’
Association made individual membership available to qualified Negro
nurses barred on grounds of race from membership in their State
nurses’ association. In early 1953, only three States remained that
did not admit Negro nurses to membership (Georgia, South Carolina
and Texas); individual membership in the national association is
open to nurses in these States.
Altogether, the nationwide shortage of nurses has helped to reduce
restrictions on employment and training opportunities for women in
this field. As a result, both the nurse candidate and the experienced
professional nurse can look ahead to general improvement in the
standards of practice and in the conditions of work.
As more nurses enter the professional field, they will find the chan­
nels and methods by which they can work toward the improvement of
nursing standards and requirements. Section VI, on Professional
Nurse Organizations, provides some information on the profession­
ally organized groups which are working for such ends.
III.—DISTRIBUTION OF PROFESSIONAL NURSES
Significance of Occupational Distribution

Close to 335,000 professional registered nurses were employed in
1951 in the United States and its territories (7). In the early 1870’s
there were only 1,200 registered nurses employed in the United States,
according to the Bureau of the Census (M) ■ In the eight decades
between, the nursing profession has grown as the country has grown,
not only in numbers but in the development of women’s careers, and
in humanitarian and industrial progress.
If a series of pictures were to be drawn illustrating nursing careers
in various historical periods, the most marked changes in nursing
would reflect changes in the economic and social life of the Nation.
For example, the two World Wars created the basis for occupational
increases and shifts. In World War I, 21,480 Army nurses were in
sendee, of whom 10,400 served overseas (52); the Navy employed
1,386 nurses in 1918 {63). By 1941 the total had decreased to 6,104
in active service in the Army and Navy. Through the United States
Cadet Nurse Corps, established in 1943, some 179,000 young women
were recruited for training as nurses (A)). In 1945, when World
War II ended, there were 65,377 nurses on active duty in the Army
and Navy.
Before the war, however, there was a marked occupational shift of
nurses from private duty nursing to hospital and institutional staff
31

jobs, probably as a result of the economic depression of the 1930 s,
when private duty employment declined.
By 1951, about half (48.7 percent) of active professional nurses
were employed in hospitals and other health institutions (.9). In
1928, less than one-fourth (23 percent) were so employed.
In the period following World War II, it was feared by some that
the release of nurses from military service would create a civilian
oversupply. On the contrary, those agencies which studied the prob­
lem, among them the Women’s Bureau (see Women’s Bureau Bulle­
tin 203-3, 1945), predicted a critical shortage. Many nurses became
homemakers and did not return to work; others left private duty for
hospital staff jobs, or left both to enter industrial nursing or office
work, where the hours were more satisfactory, thus creating shortages
in the fields vacated. Meanwhile, the need for nurses continued to
increase as a result of the extension of medical and health services,
the development of all kinds of new nursing jobs, and the maintenance
of care for veterans, as well as a rapid population growth. At the
same time, nursing schools were raising curricula standards and there­
fore required a greater number of nurse instructors, or nurses wTith
collegiate background, as well as nurses trained for specialized fields.
Occupational shifts and changes are of more than historical interest
to the nursing profession, as they delineate career changes which
directly affect job opportunities and job rewards. Of career interest,
for example, is the fact that the increase in need for military nurses
in World War I brought the establishment of a modified officer rating
(but not officer pay) to the Army nurse, and in World War II, all
military service nurses became commisisoned officers with the regular
officer pay, including retirement. In January 1953 the American
Nurses’ Association took steps toward raising the rank of commis­
sioned military nurses and also toward providing for a greater number
of promotions.
Since the war there has been a concerted effort, on the part of pro­
fessional nurse organizations, to encourage the Armed Forces to com­
mission male nurses. This action arises less from the desire to alleviate
discriminatory practice against men in one of the very rare employ­
ment fields, if not the only one, where it exists, than from the problem
of the nurse shortage in general, and the best use of nursing skills.
In a time when more highly specialized nurses and nurse instructors
are needed to staff hospitals and schools of nursing, it is thought that
men nurses are better qualified than women to serve under front-line
combat conditions and in other posts where physical requirements are
important.
On the civilian front, nurse jobs since the war have followed the
general trend toward upgrading salaries. Although many small
hospitals have been obliged to close for lack of adequate staff, other
32

hospitals have made reforms in salaries, hours, and other conditions
of work, to attract and keep nursing personnel. In New York City,
for example, the number of nurses in the municipal hospitals in­
creased from 8,400 in 194(5 to 10,500 in 1948, and the most important
single factor, acknowledged by many, to account for the increase, was
undoubtedly the establishment of a 5-day, 40-hour week in 1946.
With occupational shortages and shifts there are always corre­
sponding changes in employment specifications that are not strictly
occupational, such as age, marital status, and relaxation of physical
requirements; and also in purely discriminatory employment prac­
tices involving race or national origin. On the other hand there is a
tendency on the part of some employers to overlook skill and expe­
rience requirements and licensing restrictions with respect to the
shortage jobs. The nursing field has reflected—and continues to re­
flect—all of these trends, as critical nurse shortages have developed
in the postwar period, from 1946 to the present.
The occupational distribution of nurses may be viewed from two
aspects, cause and effect: It reflects economic and social conditions
and in its turn, creates conditions in employment outlook that are of
interest to the nurse, the nurse candidate, and the placement counselor.
Major trends in nurse distribution are summarized in the tables
which follow, and a limited discussion is included of some of the
career trends in the most significant broad fields of nursing activity.
Distribution by Type of Nurse Activity or Employer
A brief summary follows of some of the major nurse employers
and the number of nurses working for those agencies, together with
some facts about the scope of activities or kinds of positions in which
professional nurses work (see table 2).
Table 2.—Active Professional Nurses in the United States
tories, by Field of Nursing, 1951

Estimated
number

Field of nursing
Total

........ -

Hospital and other institution
School of nursing
_
.
Hospital and school of nursing

334, 733

-

--

Public health and school of nursing
Private duty _
_
In hospitals
-. ............. - - _ ____ 31,807
Outside hospitals
_
_ _ 38, 070
Industrial
__ - __
Office ....
_
_ ___ ____
Unclassified

163,
7,
4,
29,

026
701
292
650
233
69, 883

14,
28,
1,
15,

323
191
794
640

and

Terri­

Percent
100. 0
48.
2.
1.
8.
.
20.

7
3
3
8
1
9

4.
8.
.
4.

3
4
5
7

Source: Inventory of Professional Registered Nurses, 1951 (9).
249599—53—*•—6

33

The discussion which follows deals with fields that are not mutually
exclusive, but with a few exceptions, blocks out the broad occupational
distribution for both employers and types of activity, some of which
overlap. For example, nurse-midwives may be included among public
health nurses.
Nurses in hospitals and health institutions.—More nurses are em­
ployed in hospitals and health institutions than in any other field
of nursing. As a result of a survey of registered nurses made by the
American Nurses’ Association it was estimated that, in 1951, 163,000
nurses, or about half of all active nurses, were working in hospitals
and other health institutions, with about 12,000 additional nurses in
schools of nursing and hospital schools (see table 2). Some 32,000
nurses were employees of the Federal Government and the District of
Columbia in 1952 (see table 3). Other governmental hospitals in­
cluded State hospitals with 13,757 nurses, county hospitals with 12,804,
city hospitals with 14,973, and combined city-county hospitals with
2,744 in 1951 (12).
Table 3.—Ntjkses Employed by the Agencies of the Federal Government
and the District or Columbia (as Reported to the Women’s Bureau in

1952

and

1953)
Number
of
nurses

Agency

T otal

_

Veterans’ Administration
_ .
Army Nurse Corps___ _
.
Navy Nurse Corps____
Air Force Nurse Corps ____
..
U. S. Public Health Service.___
Bureau of Indian Affairs _
Gallinger Municipal Hospital
St. Elizabeths Hospital
_____
Departmental agencies (emergency
Freedmen’s Hospital.. ___
D. C. Health Department- - Panama Canal Service, __ .
Glenn Dale Sanatorium___
Tennessee Valley Authority
Other agencies 1__
.

31, 861
.
__
_

_

_____
_ _ ___ _ _ _
_.
or first aid rooms)__
___
.
_
........ ..
...

14,
6,
3,
3,
1,

200
900
332
500
500
846
286
285
250
215
188
187
72
52
48

Percent
distribu­
tion
100. 0
44. 6
21. 7
10. 5
11. 0
4. 7
2. 7
.9
.9
.8
.7
.6
. 6
.2
.2
.2

^Includes Institute of In ter-American Affairs, 33; Children’s Bureau, 12; Federal Civil Defense Adminis­
tration, 2; and Civil Service Commission, 1.

Reports from hospital administrators collected by the American
Medical Association for the same year (1951) add up to a much larger
total—247,854 professional nurses in hospitals (see table 1). The
34

-

^'

Figure 6.—Maternity ward nurse registers footprint for identification of
newborn child in hospital.
greatest concentration of these nurses was found in the general hos­
pitals, with 219,775 nurses reported in that field. The number of
professional nurses of all types increased 4.1 percent between 1950
and 1951. In fact, all types of nursing showed increases in that period
except private duty nursing, which showed a decrease of 2.8 percent.
The percentage increase was greatest in Federal hospitals. Hospitals
for nervous and mental patients had 11,966 nurses, and tuberculosis
hospitals 6,783 (12). With more than 18 million admissions into
hospitals each year (32), a large proportion of the population is
affected directly or indirectly by the hospital.
Federal Government service.—In the Federal Government hospitals,
nurses for the most part are civilian employees, except in agencies
where they may be commissioned officers. In the hospitals of the De­
partment of Defense and in the United States Public Health Service
both civilian nurses and commissioned officers are employed. The
civilian employees of the Public Health Service and of the military
forces are under civil service as are the employees of the Bureau of
Indian Affairs, the Panama Canal, the Children’s Bureau, Freedmen’s,
St. Elizabeths, and Gallinger hospitals, Glenn Dale Sanatorium, and
nurses in first aid and emergency rooms in Federal buildings. Nurses
not under civil service are the commissioned officers of the Public
35

Health Service and the Armed Forces nurses, those working for the
Tennessee Valley Authority, the Institute of Inter-American Affairs,
the Veterans’ Administration, and certain other Federal agencies
involving security risks.
The Veterans' Administration, which employs more nurses than any
other agency in the Federal Government, has nursing services in
Veterans’ Administration hospitals and in its regional office clinics,
centers, and domiciliaries. In January 1952, 14,200 nurses were serv­
ing in 152 hospitals, centers, and domiciliaries and in 73 regional
offices. Since 1946 a Nurse Professional Standards Board, composed
of nurses, has the appointing function for the agency. In that year
Veterans’ Administration nurses were removed from civil service
and became a part of the newly organized Veterans’ Administration
Department of Medicine and Surgery. Veterans’ Administration
nurses participate as team members with physicians, dentists, psychol­
ogists, social service workers, physical and occupational therapists, and
allied workers in an active medical program directed toward total
patient care and rehabilitation.
The Army had about 5,300 military nurses in the Army Nurse Corps
in 1952 and in addition about 1,600 civilian nurses employed under
civil service regulations. The number of Army nurses fluctuates with
authorized troop ceilings because of the ratio of 6 nurses per 1,000
troops. The minimum of Regular Army nurses authorized by law
in 1952 was 2,558 regular nurses with the remaining number of mili­
tary nurses on duty as Reservists. Army nurses are assigned as
general duty, pediatric, communicable disease, operating room, anes­
thetic, obstetrical, and neuropsychiatric nurses, as clinical specialists,
as nurse administrators who are chief nurses, and as Army health
nurses who are similar to public health nurses.
The Navy in January 1952 had 3,332 nurses in its Navy Nurse
Corps including a captain, 15 commanders, 58 lieutenant-commanders,
1,765 lieutenants, 606 lieutenants junior grade, and 887 ensigns. The
ensigns and lieutenants junior grade are staff or general duty nurses.
Flight nurses are also in these grades. Some of the lieutenants work
as staff or general duty nurses but those with senior service may be
found in supervisory and administrative positions. The lieutenantcommanders and the commanders have supervisory and administra­
tive positions exclusively.
The United States Air Force Nurse Corps had over 2,850 commis­
sioned nurses on active duty in 1953 and almost 700 civilian nurses,
according to general estimates. The commissioned nurses included
more than 200 administrative nurses, more than 100 psychiatric nurses,
about 300 operating room nurses, more than 100 anesthetists, and about
2,100 general duty nurses. The general duty group is made up of
36

staff nurses in the hospitals (over 1,950) and flight nurses (150) giving
care to hospitalized patients in transit.
The United States Public Health, Service employed in 1952 about
1,500 nurses distributed between the national offices in Washington,
D. C., 23 agency hospitals, and 18 out-patient clinics throughout the
country. Of the hospitals, 18 were general and located on coasts
and waterways; there were 2 tuberculosis hospitals, 2 neuropsychi­
atric, and 1 hospital for sufferers from Hansen’s disease (leprosy) at
Carville, La. The Public Health Service hospitals serve American
seamen, officers and enlisted men of the Coast Guard, officers and crew
members of the Coast and Geodetic Survey, Federal employees injured
at work, and commissioned officers of the Public Health Service.
Public Health Service nurses also work in medical and psychiatric
units of certain Federal penitentiaries and are consultants in FederalState cooperative programs.
The Bureau of Indian Affairs in the Department of the Interior
provides complete health service for those Indian wards of the Nation
designated as beneficiaries of the Government by treaty or by law.
To provide them with medical service the Bureau operates 56 hospitals
and sanatoriums west of the Mississippi River for Indians and 8
hospitals in Alaska for Indians and Eskimos. They are situated
in rural areas in the most scenic, although undeveloped, parts of the
country. Hospitals of the Bureau of Indian Affairs are relatively
small and range from 18 to 335 beds with staffs of 5 to 90 nurses.
In addition to the hospitals, medical service is provided through com­
munity clinics or hospital out-patient stations.
Indian women are given preference in hiring for nurse positions,
but because there are very few Indian nurses most of the nursing
staff, to date, come from other groups. Most of the nurses are single;
married women are not employed unless their husbands are also
employed by the Bureau at the same location.
The total number of institutional nurses, including directors and
head nurses, in the Bureau of Indian Affairs was estimated to be
761 in 1952; in addition, 87 public health nurses employed by the
Bureau travel by plane, boat, and dog sled to native villages.
Other Federal agencies that employ nurses are listed in table 3. The
Federal Security Agency has jurisdiction over St. Elizabeths Hospital
in Washington, D. C., which employed 285 nurses in 1952, and Freedmen’s Hospital with 215. Gallinger Hospital and Glenn Dale Sana­
torium in the same metropolitan area are under the jurisdiction of the
District of Columbia municipal government with nurses under Federal
civil service regulations. They employed 286 and 72 nurses respec­
tively in 1952. In first aid and emergency rooms of the Federal
Government buildings in Washington, D. C., about 250 nurses were
estimated to be working. The Panama Canal had 187 nurses in 1952
37

in its two hospitals—one at each end of the canal. The Tennessee
Valley Authority employed 52 nurses in 1952. The Children’s Bureau
had 12 nurse consultants with a beginning grade of GS-11 who were
specialists in pediatric or midwife fields. Small numbers of nurses
scattered among other Federal agencies brought the total of nurses
in the Federal and District governments in 1952 to nearly 32,000.
The District of Columbia nurses are discussed in the section following
under public health nursing.
Public health nursing—State and local agencies.—Relatively few pub­
lic health nurses work for the Federal Government. The greatest
number are to be found in State or local agencies and in private
health organizations.
The United States Public Health Service reported a total of 25,788
public health nurses working in the country in 1952, and 25,461 in
1951—much smaller totals than the 1951 figure of 29,650 obtained
through the American Nurses’ Association inventory. The PHS
figure, however, excludes nurses employed in industries, nursing
education institutions, and those employed by national agen­
cies for nationwide or regional services. The largest number were
employed by local public health agencies, which reported a total of
12,433 nurse employees. In addition, local boards of education em­
ployed 6,456 nurses; local private agencies 4,668; State agencies 1,362;
schools of nursing, both hospital and collegiate, 402; and national
agencies, 467. Over 88 percent of these were staff nurses (7, p. 27).
Of the 25,461 public health nurses reported by the Public Health
Service in 1951, 391 were consultants (27 of them part-time workers)
specializing in one of the many fields of public health nursing. They
were employed by State and local agencies as follows: 78 in maternal
and child health; 97 in orthopedic work; 45 in educational guidance;
44 in tuberculosis nursing; and the remainder in various other types
of work. The orthopedic specialists were engaged in programs for
crippled children and children with cardiac conditions, including
victims of rheumatic fever. Of the total, 14 had no college education,
82 had some college training but no degree; 238 had a bachelor’s
degree, and 57 a master’s or other advanced degree. As for training
in an approved program of public nursing study, 31 had no special
training, 29 had less than 1 year of training, and 331 had 1 year or
more of such training (70).
In most States there are 2 or more public health nurses on the State
health department staff and many others in county and municipal
health departments; but in 1952 there were 668 counties and 13 cities
without such facilities. It is estimated that public health nurses
serve 5 million families in a year, or 1 family in 8, making an annual
total of 17.5 million visits to homes, in addition to their work in clinics,
38

classes, conferences, and schools. They also make surveys and follow­
up reports of contagious diseases (39).
The public health service in Washington, D. C., is managed as a local city
administration by the bureau of public health nursing in the District of Columbia
Health Department, but it is unique among cities in that it is directly under
the jurisdiction of the Congress, although its operation is similar to that of a
State health department. The nurses are selected under the Federal civil service
system and have the regulations and salaries of Federal Government employees.
Nurse beginners are hired at the GS-5 level; they must be graduate nurses with
some field experience in public health before they can be employed. In June
1952, the bureau had 68 nurses at this level, known as trainees. Whenever they
earn their master’s degree they are in line for promotion to the GS-7 grade.
In 1952, 62 nurses were working at GS-7. In addition 12 others were on the staff
at GS-9 or above. (See appendix for Government entrance salary.)
The main duties of District of Columbia public health nurses are to educate
patients, their families, and the community at large in the principles of healthful
living; to investigate for epidemiology, that is, the control of communicable and
noncommunicable disease; to coordinate their work with that of other community
resources such as hospitals, the social service exchange, and social welfare
agencies; and to participate with physicians in the operation of clinics. In
addition to the nurses in the District of Columbia public health service, about
5 or 6 public health nurses are employed by the board of public welfare, and
the city board of education has about 35 public health nurses.

Visiting nurses, as public health nurses in many private agencies are
called, give valuable service mostly in the more populous areas rather
than in rural districts. They are fewer in number than those employed
by governmental units, but they usually have high standards and
carry out important and public-spirited programs.
For instance, a visiting nurse association in a large eastern city reported that
its 175 nurses had made one or more visits to nearly 52,000 patients during 1950,
including premature babies, elderly people, and chronic sufferers from diabetes,
heart disease, cancer, and arthritis. The agency charged for visits on a cost
basis; patients who were able to pay were asked to do so. Operating deficits
were met through a public fund campaign. The visiting nurse’s salary is, of
course, independent of patient fees. Workmanship-like service at the lowest
possible cost characterizes the visiting nurse programs in private organizations
which have no governmental support through which to defray their expenses.
These nurses are relatively few—about 5,000 in 1901—and are highly regarded
in their communities.

School nurses—public and private.—An important branch of public
health nursing is school nursing. In 1952, 6,456 public school nurses
were reported in the country (7, p. 27). A study of 139 school nurses
in supervisory work in 1951 indicated that 75, or 54 percent, of these
supervisors had had some college work and 57, or 41 percent, had
received 1 or more college degrees. Almost all had taken some courses
in an approved program of public health nursing study: 55, or almost
40 percent, had had less than 1 year of this training and 69, or 50 per­
cent, 1 or more years of training. Of 5,790 staff nurses for whom
information was available, 3,346, or 58 percent, had had some college
39

4

training but no degree; 1,075, or 19 percent, bad received 1 or more
degrees; 2,029, or 35 percent, had taken less than 1 year in a program
of public health nursing study; and 1,677, or 29 percent, had spent
1 or more years in this program (70).
School nurses work under various types of program. For instance,
in a popidous area in the East, a force of 29 school nurses with a
qualified supervisor administered the State school nursing program
in 1945. The State board of health provided in-service training pro­
grams for the nurses. Books on health subjects were selected for loan
kits for the county schools. Motion pictures were also available for
use in the schools (20 ).
Conditions are very different in many rural counties. In one agri­
cultural district in 1949, as described in the Journal of School Health,
the county health supervisor was the only nurse for 11 rural schools.
She combined administrative duties with service as a staff nurse for
more than 5,000 children. Members of the senior health classes in
the various schools were ingeniously divided into committees of three
or four to assist in such programs as immunizations, physical and
dental examinations, hearing and vision tests, preschool clinics, and
milk programs. This plan greatly broadened the scope of the county
health program and developed an interest in community school health
programs.
In addition to the 6,000 public school nurses, a few nurses are
employed in private schools and camps.
An instance of school nursing in a private setting is that of a year-round
school camp in a midwestern State accommodating 120 children, usually for a
2-week period. Attendance is voluntary. Financial assistance is provided by
private organizations for those unable to pay the usual fees. A camp nurse,
responsible for the health of the children and the counselors, tests the water
supply at monthly intervals, makes periodic examination of food handlers,
inspects the sanitary conditions of the kitchen and the food, cares for the sick
or injured, and conducts classes in health education at the camp (51).

Industrial nurses.—Estimates of the number of nurses employed in
industrial, commercial, and service establishments in 1951 varied from
14,323 by the American Nurses’ Association Inventory of Professional
Registered Nurses to 11,910 by the United States Public Health Serv­
ice. According to the Census of Industrial Nurses prepared by the
Division of Occupational Health of the Public Health Service, the
number of full-time registered nurses employed in industry increased
approximately 30 percent from 1946 to 1951. As of January 1, 1951,
the duties of 8,355 of these industrial nurses were indicated as follows:
The great majority, 85.4 percent, were in-plant workers; 11.9 percent
worked in industrial hospitals; 1.7 percent were home or visiting
nurses; and 1 percent were employed in personnel departments. In
the same survey the educational backgrounds of 6,762 of these indus­
trial nurses were reported: 6.9 percent were not high-school graduates,
40

6D.6 percent had a high-school education but no college, 19.6 percent
had some college work but no degree, and 6.9 percent had one or more
college degrees (7, p. 35). A 1951 survey by the National Association
of Manufacturers, covering 3,500 companies with over 3.3 million
employees, indicated that 28.5 percent of these companies with 2.5
million workers employed one or more full-time professional nurses
m.
Distribution of nurses according to type of industrial establishment
follows a varied pattern in size of staff and nature of duties. A mid­
western company with 3,000 employees has had a visiting nurse pro­
gram for more than 35 years in addition to the nurses in the plant.
In 1950, four registered nurses devoted their entire time to visiting
sick or injured employees and those retired because of ill health.
Various supplies were loaned to the patients and books and radios
were provided during illness. Information on job security was often
asked by the patients {36).
An oil company in the Southwest, in addition to in-plant nurses,
employed nine nurses known as field or visiting nurses, in 1948. They
served in both urban and isolated areas. Each nurse was in charge
of a geographical division and was supplied with a company-owned
car equipped with supplies. Often the nurse traveled over 100 miles
a day while on the job; other duties included lecturing to groups of
employees and their families, speaking at meetings such as the parentteacher association or Girl Scout groups, operating a free lending
library for employees, and acting in the capacity of personal counselor
m.
Office nurses.—In 1951, 28,191 nurses or 8.4 percent of all nurses
were estimated to be employed in doctors’ and dentists’ offices through­
out the country (,9). Often the doctor’s office nurse is the only nurse
on the staff, but doctors with large practices may employ more. For
instance, a New York specialist in gynecology and urology employs
two nurses and a receptionist. One nurse is a supervisor who also
serves as the physician’s secretary, takes case histories and X-rays,
and makes minor laboratory examinations. Slxe arranges for opera­
tions and discusses costs and home problems with patients. The other
nurse is the doctor’s assistant in surgery who prepares the operating
room and administers anesthesia. In a still larger office of an up­
state New York obstetrician with an assistant physician, there are
four registered nurses, and a secretary. The nurses make home visits
for the doctors and considerable responsibility is placed upon them.
Classes in prenatal instruction are held in some offices, so that train­
ing or experience in public health nursing is necessary for this type
of work {21).
Nurse instructors.—In 1951 there were some 12,000 nurses em­
ployed in schools of nursing and in hospitals with schools of nursing
41

Figure 7.—Nurse in physician’s office takes a blood sample for testing.
(table 2). A survey of 1,124 schools of nursing in 1949 reported
10,477 nurse instructors. Of this number, 4,752 had no college de­
gree, 4,581 had a bachelor’s degree, and 1,144 had a master’s degree
(72). In addition to nurses, other instructors in schools of nursing
include physicians, members of college faculties, dietitians, medical
technicians, and science instructors.
Psychiatric nurses.—Psychiatric nursing is a field which offers many
types of work for graduate nurses: hygiene clinics, child guidance
centers, and departments of education, mental health, or public wel­
fare. In 1951, 11,966 nurses were estimated to be employed in the
mental health field at all levels, from directors and supervisors to
staff nurses. In 1950, over 600 of these were men. The staff nurses
comprised more than two-fifths of the entire group. The 1951 In­
ventory of Professional Eegistered Nurses indicates a nurse-patient
ratio of 1 to 61 in nervous and mental hospitals. In these same in­
stitutions the attendant-patient ratio was 1 to 8 (9).
Tuberculosis nurses.—Tuberculosis nursing is a relatively small field
in which 6,783 nurses were estimated to be employed in 1951. Of
these, 238 were part-time general duty nurses and 88 were full-time
instructors; but the largest number, 3,468 or over one-half, were full­
time staff nurses in tuberculosis hospitals or institutions (1%). This
42

does not include tuberculosis nurses in general hospitals. One nurse
to three annual tuberculosis deaths is considered a valid ratio but
few States have attained this standard. A heavy reduction in the
number of tuberculosis nurses occurred during World War II re­
sulting in a ratio of 25 to 40 or more patients per graduate nurse.
This field has been understaffed ever since (J10).
Nurse-midwives.—According to estimates by the National Organiza­
tion for Public Health Nursing there were approximately 365 nurse
midwives in the country in 1949, some of whom were graduates of
foreign schools. A study of 55 of them indicated that 80 percent
had college degrees in general education, public health nursing, or
nursing education (6, p. 81).
The activities of nurse midwives in the Frontier Nursing Service
in the remote regions of the Appalachian Mountains are unique. The
principal agency in one mountain district serves three rural counties
and has a hospital and a dispensary offering services to 12 nursing
areas in 8 centers; the nurses are required to visit patients in isolated
areas. In the Frontier Graduate School of Midwifery, which is
a part of this agency, registered nurses are given a 6-month course
in midwifery. Trained nurse-midwives work under medical direc­
tion. Medical, nursing, public health, and social service as well as
midwifery service are provided for the mountain people through
this agency, but the nurse-midwives are the mainstay of the health
program. A small group of nurses work as nurse-midwives in several
large urban centers, chiefly New York City and Chicago. All have
specialized training, sometimes requiring 1 year, which combines
classroom and practical experience.
Nurses in foreign service.—The Federal Government employs some
nurses outside of the United States. In 1952, 187 served in 2 hos­
pitals in the Panama Canal Zone for the benefit of the military and
civilian population as well as those on shipping passing through the
canal (7, p. 37). In addition to nurses from the Bureau of Indian
Affairs, the Federal Security Agency had 6 public health nurses sta­
tioned in Alaska, making a total of 133 there. In Latin America
the Institute of Inter-American Affairs employed 28 nurses in 13
countries. The Department of State, Division of Foreign Service,
had 18 nurses in charge of health rooms at foreign service posts in
Europe and Asia. Even in peacetime some nurse officers of the Armed
Forces serve overseas in military hospitals, on shipboard, and on
planes in flight duty; in time of war, all are subject to assignment
to any foreign post.
The United Nations in its World Health Organization, popularly
known as WHO, sends out nurses to various parts of the globe. In
1950, some 20 nurses were employed by WHO in teams with a doctor
and a sanitary engineer. Their job was to carry out health measures
43

and teach nutrition, mental hygiene, and maternal and child care, as
part of the general objective of WHO is to attack world diseases and
to advance the idea of freedom by providing some of the instruments
which make people self-reliant. The nurses worked on health teams
in Iran, Iraq, Yemen, Israel, and Ethiopia in 1952 training local
women in simple nursing procedures (&4)- In some areas, schools of
nursing are established and fellowships granted to train local health
personnel (41).
Religious and private welfare organizations have openings for
nurses overseas from time to time. Church missions employ staff
nurses, public health nurses, and nurse educators in various parts of
the world, such as the Belgian Congo, the interior of Brazil, aud
India. Several American companies with large business offices
abroad employ nurses among their personnel. The American Nurses’
Association is an active member of the International Council of Nurses
and sponsors an Exchange-Visitor Program, whereby American
nurses are sent abroad in exchange for foreign nurses.
jN,//i'scs in the American National Red Cross. In 1952, 650 Red Cioss
nurses were reported serving in 32 States during poliomyelitis epi­
demics. The Red Cross has an agreement with the National Founda­
tion for Infantile Paralysis to recruit nurses for service during these
epidemics. In the blood-donor program for the same period, 1,300
paid nurses and 2,600 volunteer registered nurses were active in 60
blood centers. A paid staff is used for supervisory purposes at each
blood center but volunteer nurses usually serve as staff nurses. In the
disaster field a reserve nursing roster is kept in each chapter so that
nurses, both active and inactive, may be called in case of need. In
1951-52, 2,325 nurses served on 40 disaster operations (7, p. 39).
This group becomes increasingly important under the civil defense
program.
The Red Cross also recruits professional nurses to train instructors
ju several types of health education. The 709 trainers of class in­
structors in the 9-month period in 1951-52, gave courses of 30 hours
to instructors who, in turn, taught at the chapter level. The chapter
educational program consists chiefly of a home nursing course, a
mother-and-baby-care course, and nurse aide training. As part of
civil defense planning, the Red Cross hopes to increase the number of
persons instructed.
Although the policy is followed, on the whole, of employing only
professional nurses to train Red Cross instructors, many of the in­
structors of community classes are not professional nurses. As large
a number of volunteer, non-professional instructors as possible are
recruited in order to spread the funds of the organization. However,
if the need for instruction is evident and no unpaid volunteer is
44

available, a paid instructor who is also a professional nurse may be
hired for the work.
Nurses in Part-Time Employment
Part-time work is generally accepted in the nursing profession.
The American Medical Association estimated that 23,772 part-time
general duty nurses were employed in hospitals and schools of nursing
in 1951. The great majority, 22,616, worked in general hospitals, 266
in nervous and mental hospitals, 238 in tuberculosis hospitals, and
652 in other types of hospitals {12).
A recent survey of part-time work for women undertaken in 1,071
establishments in 10 cities by the Women’s Bureau of the U. S. De­
partment of Labor in various geographic areas {62) included 436
registered nurses doing part-time work in 49 hospitals; 15 other part­
time nurses in 9 social agencies; 2 in preschool nurseries; 3 in doctors’
or dentists’ offices; and 1 each in a private school and a college. In a
study of 154 of these part-time nurses, high school education or less
was reported by 60 percent; 36 percent had from 1 to 4 years of college;
and 3 percent had done post-graduate work. One of them, a married
woman between 40 and 45 year's of age, was a high school graduate
and had completed a nurse’s training course. She did general duty
work as a nurse in a hospital for 20 hours a week, from 7 a. m. to 3: 30
p. m. on Sunday and from 7 p. m. to 11 p. m. on Monday, Tuesday, and
Wednesday. Her husband cared for the two children aged 7 and 11
years while she worked. A married woman in the 45 to 50 age group
with 3 years of college and nurse’s training had three children from
17 to 21 years of age. She was employed as a nurse in a pediatrician’s
office 27y2 hours weekly. The most usual schedule for part-time
nurses which hospitals preferred was found to be 3 days of 8 hours
each. About half the hospitals gave these workers paid vacations and
one-fourth gave sick leave, prorated on the basis of the time they
worked. They were usually paid the same hourly rate as regular
nurses in the hospitals {62).
Employers find part-time nurses useful in covering peak loads, busy
periods, or regular nurses’ days off duty and in relieving the nursing
shortage in general. Although they are not so familiar with the con­
dition of the patients and are less interested in the individual patients
than the regular nurses, on the whole their service is satisfactory.
One-fourth of the establishments reported unreliability of younger
part-time nurses in attendance as illness of the husband or young chil­
dren and other home responsibilities at times interfered with their em­
ployment. Older ones were found to be more dependable. The
nurses themselves seemed to feel conscious of the public need for their
services and they appreciated the opportunity to keep in touch with
new methods in the nursing field and with the drugs and medicines in
current use {62).
45

Geographic Distribution and Job Opportunities
Geographic distribution of nurses follows closely a general trend in
the development of medical and health facilities in communities. In
general, rural sections of the country have less than their propor­
tionate share of nursing service because urban areas have a greater
number of medical facilities, and the urban scale of living creates
higher salary ranges for nurse positions, as well as a greater number
of position openings.
Although there is a positive correlation between concentration of
high average incomes and medical care resources in the various States,
there are some exceptions. For example, New Hampshire and Ver­
mont in 1949 had more nurses in relation to income than the national
average (34).
Table 4.—Geographic Distribution ob’ Graduate Nurses in Hospitals,
Number op Hospital Beds, and Population in the United States, 1951
[Percent distribution]

Graduate
nurses in
hospitals1

Region
United States
North Central
South__
_
West..__

__ __ . _ _ ..
__
-

-

-

Hospital
beds

Population
(estimated)

100. 0

100. 0

100. 0

33.
29.
21.
15.

32.
29.
25.
13.

26.
29.
31.
13.

1
3
8
7

6
0
2
3

0
4
3
2

i Includes administrative nursing personnel, full-time instructors, supervisors and assistant supervisors,
head nurses and assistant head nurses, full-time and part-time general duty nurses, and nurses not classified.
Excludes 114,646 student nurses and 31,807 private duty nurses.
Source: Journal of American Medical Association, May 10, 1952, and U. S. Bureau of the Census, Series
P-25, No. 62.

As indicated in table 4, about 33 percent of nurses lived in 1951 in
the northeastern section of the United States, over 29 percent in the
north central section, 22 percent in the South, and 16 percent in
the West. The table compares this distribution with that of the
population and the supply of hospital beds in those areas. The west­
ern and northeastern States had a higher proportion and the South a
lower proportion of nurses in relation to the number of people in these
areas. The small proportion of nurses in the South follows the gen­
eral trend among medical and health personnel and facilities with
which the South is less generally well supplied than other parts of the
country.4
4 Regions as designated in U. S. Census reports are used throughout: Northeastern
States—Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York,
Pennsylvania, Rhode Island, Vermont; North Central States—Illinois, Indiana, Iowa,
Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota,
Wisconsin ; Southern States—Alabama, Arkansas, Delaware, District of Columbia, Florida,
Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South
Carolina, Tennessee, Texas, Virginia, West Virginia ; Western States—Arizona, California,
Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming (55).

46

IV.—TRAINING FOR A NURSE CAREER

Preparation Begins in High School
Four years of high school are required for a candidate to enter an
accredited nursing school. To prepare adequately for nursing school,
the high-school student should take as much as she can of the science
courses offered, including general science, chemistry and/or physics,
and at least 2 years of mathematics. The social sciences should not be
neglected, and wherever they are offered, the nurse candidate will
profit by taking high-school courses in civics, modern history, and
psychology (or general courses in human relations). Physiology,
biology, and hygiene or nutrition are obviously important studies,
and the regular courses given in most high schools in home economics,
particularly in food preparation (rather than in crafts like dress-

Students preparing solu­
tions in a laboratory
class.

Student nurse gives medication under
supervision of the head nurse.

■

■

Students learn the use of
a respirator for a
poliomyelitis patient.

Figure 8.—Nurse training combines classroom work and hospital practice.
47

making or design, if there is a choice) will help to prepare the
candidate for nursing school.
High-school preparation is not limited to science and related courses.
The nurse candidate should pay close attention to her required highschool English courses, the social studies, and also take modern
language, if possible, for the increasing standards of the nursing
profession require that the nurse be a wTell-rounded person. Her
relationships with her patients and coworkers will be enriched and
her professional status increased to the extent that she is able to
participate in the world in which she lives.
Because high schools differ from place to place in their course con­
tent, the student should consult her high school adviser or a faculty
counselor, as early as possible, as to whether she is taking the right
combination of required courses for a nursing career. The more that
a student takes beyond the minimum required, the easier her experi­
ence will be in nursing school, later.
Minimum Requirements for Entering Nursing Schools
To enter an approved school of nursing, the student is usually
required to be a high-school graduate between 18 and 35 years of age,
although some schools will consider girls younger than 18. A few
schools have minimum requirements of 20 years of age and 2 years
of college training for entrance and some admit only those from the
upper one-third or one-half of their class.
Nurse Training Is in Transition
The minimum training period for obtaining a professional nurse
diploma is 3 calendar years in a hospital school or from 40 to 48 months
in a collegiate school of nursing.
Until the early 1900’s in the United States, all nurses obtained their
training in hospital schools of nursing. In 1909, the University of
Minnesota opened its doors to nurses with a combined college-andnursing course. Shortly thereafter, other colleges developed nurse
training programs. In the past quarter of a century, the number of
collegiate schools of nursing has grown rapidly. The National
League for Nursing reported that there were 144 such schools as of
January 1,1952, of which all but 17 offer an integrated course leading
to the bachelor’s degree and registered nurse license (7, p. 62).
Hospital schools for nurses were started in the 1870’s in the United
States, and increased until there were well over 2,000 such schools in
1920. Today, over 1,000 hospital schools still offer nurse training,
but many of the small ones have closed their doors because they were
not able to obtain students. Revision of nurse education is taking
place in some hospital schools to place greater emphasis on the educa­
tional needs of the student and less on the service needs at the hospital.
Although many young women still enter hospital schools of nursing,
48

which have improved their standards and widened their training hori­
zons since the turn of the century, a steadily growing number of candi­
dates for the professional nurse occupation are entering collegiate
schools of nursing.
The changing trend toward integration of college courses with nurse
training is not surprising, in view of the increased demands made
upon the nurse for occupational competency. The number and range
of job possibilities, compared with those available to nurses 50 years
ago, has determined, for the most part, the changing pattern of nurse
training.
Changes in the professional nurse function, especially in hospital
and institution jobs, also account for the changes in nurse education.
The recent approach in assigning duties to the professional nurse is
to put her in charge of a nursing team together with the practical
nurse and auxiliary hospital workers, which means that she has super­
visory responsibility, but also gives expert nursing care. The extent
to which the nursing team idea can be developed depends, in a large
measure, upon the preparation of the professional nurse.
It has been predicted by professional nurse and medical groups
that there will be an increasingly sharper distinction between the
practical nurse, of whom comparatively little is required in the way
of assuming responsibility for decisions and in technical knowledge,
and the professional nurse, who may, even in the next decade, need
college-level preparation to qualify for her license.
There is no doubt that our Nation needs all kinds of nurses, and
that the qualified practical nurse, the hospital-trained nurse, and the
professional nurse with college training can all serve in their occupa­
tions in equally necessary ways. The fact that nurse training is under­
going a change in trend, however, presents a problem for the nurse
candidate to consider as early as possible in her career. Questions
about the kind of training a young woman should take to become a
nurse should be answered after she has examined her own personal
needs, interests and qualifications, her career goals, and the kind of
training available.
The Hospital School

The hospital school is the basic traditional school which grants a
nursing diploma. The graduate of a hospital school is sometimes
called a diploma nurse as distinguished from the college-trained nurse.
In January 1952,1,011 hospital schools of nursing were in operation
with an average enrollment of 85 (7, p. 62). Of the 90,888 nursing
students enrolled in diploma courses, the great majority (85,023) were
in hospital schools. In 1949, about one-fourth of all general hospitals
had schools of nursing or provided clinical facilities for collegiate
schools; 97 percent of hospital schools of nursing were associated with
49

general hospitals. Few specialized hospitals offered training pro­
grams. Schools were operated in 80 percent of the large hospitals,
that is, those with a daily average of 200 patients or more {72).
Students in some hospital schools attend classes in colleges or uni­
versities in addition to the classroom instruction given at the hospital.
Instructors at the hospitals may include physicians, graduate nurses,
specialists, or college instructors who come to the hospital to conduct
classes. Class work usually covers such subjects as symptoms of
various diseases, the action of medicines, diets, the differences between
sick and well people, and the meaning of health. A few schools offer
specialties such as psychiatric nursing, the theory of mental hygiene,
or lectures on subjects such as eye, ear, and throat diseases.
In addition to classroom training the student nurse is given clinical
training in a hospital under the supervision of graduate nurses.
This means actual nursing in a hospital, working with patients.
Clinical experience covers the basic fields of general medicine, sur­
gery, obstetrics, and pediatrics. In 1949, 5 percent of the schools
were restricted to these four programs; 24 percent offered experience
in 5 fields—usually the 4 basic services and psychiatry; 71 percent
offered experience in 6 fields or more—including at least 1 of the
following: Tuberculosis, communicable disease, out-patient work,
public health, nursery school, or rural hospital nursing. Where a
certain type of experience is not available in the home hospital, affilia­
tion with a large or specialized hospital is usually arranged for the
students. In 1949, 33 specialized hospitals offered training; 25 men­
tal, 4 tuberculosis, 2 pediatric, and 2 maternity-pediatric (72).
Hospital schools vary a great deal in the specializations offered, and
accreditation advisers, like the National League for Nursing and the
licensing boards for nurses and nurse education in many States, are
constantly at work, in conference with nursing school faculties, to
revise and improve the courses of study.
In medical nursing, 12 to 24 weeks’ experience on a service with not
less than 25 patients is usually considered adequate by accrediting
authorities. In this basic course, students learn bed making, moving
and bathing patients, recording temperatures, pulse, and respiration,
and preparation for operations. In surgical training, they assist in
the operating room, dress wounds, sterilize instruments, and admin­
ister special apparatus and therapy. Surgical nursing for 22 to 36
weeks with at least 50 patients is recommended by those in the profes­
sion; obstetrical nursing for 12 to 20 weeks with 25 patients, and
pediatric nursing with 25 child patients for 12 weeks or longer. For
well-rounded training, experienced nurses recommend in addition 12
to 16 weeks of psychiatric nursing with 25 or more patients, 4 to 12
weeks of tuberculosis nursing with at least 25 patients, 4 to 12 weeks
of communicable disease nursing with at least 25 patients, and 4 to
50

12 weeks of public health experience. Besides these, nursery school
training offers experience in the pediatric field with normal children,
and rural nursing offers valuable rounding out of experience if train­
ing has been confined to a large city hospital (72). Out-patient work,
health clinics, and home visitation are other phases of the work which
make the nurse aware of the pathological conditions of the ambulatory
patient and of the social and health factors affecting the patient and
his family.
The particular kind of course which a hospital school may offer is
very important to the nurse candidate. If a student cannot decide,
with the help of nursing school catalogs and the advice of her local
high school counselor or her State board, what school to attend, she
may write for information to the Committee on Careers in Nursing,
2 Park Avenue, New York, N. Y.
Conditions of hospital school training.—Tuition and other costs for a
nursing education program vary widely with schools of nursing.
Some schools require an entrance fee; others do not. The prospec­
tive student should inquire of the directors of the schools which she
is considering or write for the school catalog, in which fees will be
indicated. In addition to fees, the student will need to take care
of her own personal expenses and her transportation to and from
school if she plans to attend a school distant from her home.
In some hospital schools of nursing, tuition is low in cost or free.
Board and room are usually supplied; uniforms and professional
laundry are frequently provided in addition. About one-third of the
schools permit 3 weeks or more of sick leave; one-third, 2 weeks; and
the remaining third, 1 week or none. If none is permitted, the stu­
dent who loses time because of sickness must make it up later by
arrangement with her instructors. As for vacations, three-fifths of
the schools give 3 weeks, and most of the others give 4 weeks. Some­
what more than half of the schools have a workweek of 48 hours; most
of the others have a shorter workweek, ranging from 40 hours or less
to 47 hours. These hours include classroom activities and laboratory
and clinical experience, but not study time (72).
In the past, when training was given almost exclusively in hospitals,
many schools leaned more toward the apprenticeship system than is
usual in most professions. Some hospitals depended upon the services
of student nurses to an unwarranted extent. Students who dropped
out of the training courses complained of overfatigue from long hours,
extended night duty, and other exacting physical demands. Many
complained of inadequate social programs and lack of recreational ac­
tivities. The tradition of some of the institutions fostered the isola­
tion of the student in special parts of the dining room, and enforced
formality before instructors. Personnel counselors were unknown in
the hospitals in the early days when little concern was given to the
51

welfare of the individual student. On the other hand, many of the
students were immature and unable to meet the demands of the job.
Today, hospital schools are not only making the training more attrac­
tive, but are raising admission standards and requirements. The ad­
mittance age has been raised to 20 years in some schools and for some
hospital courses girls are encouraged to have 2 years of college work
before entering training. Aptitude tests and counseling interviews
are being used to eliminate candidates who are not likely to succeed.
Progressive hospital schools are extending the range of academic
work and decreasing the number of hours required of the student
nurse in performing routine hospital duties. At the same time, they
are enlarging the social and recreational opportunities for the nurse
in training. Student activities and various forms of student self­
government are part of the programs of modern hospital schools (15).
Collegiate Schools of Nursing
In 1952 there were 144 collegiate schools of nursing, of which all but
17 offered programs leading to a bachelor’s degree, according to the
National League for Nursing. The number of students working to­
ward a nursing degree totaled 10,921, of whom 9,625 were in collegiate
schools. The proportion of students in degree programs has increased
from 5.6 percent in 1946 to 10.7 percent in 1952 (7, pp. 49, 62).
Collegiate nursing programs require that half of the training time
be spent in general education including basic science, biological sci­
ences, and social studies; and in English composition, literature, and
the humanities. The remainder of the program is a combination of
classroom work and practice in clinical fields such as general medicine,
surgery, obstetrics, pediatrics, and psychiatry.
Wide variations exist today in the pattern and amount of time spent
on academic subjects and nursing subjects in the universities and col­
leges which offer the combined program. A collegiate degree nurs­
ing course may vary from something less than 4 years after high school
to
academic years beyond high school. Eventually, the collegiate
nursing curriculum may become standardized, and groups of edu­
cators, professional nurses, and medical specialists are giving consid­
erable study and thought to this question. Meanwhile, the student
may refer to the list of accredited collegiate nursing schools in the
Yearbook of the American Council on Education, “American Univer­
sities and Colleges,” and also write to the Committee on Careers in
Nursing, 2 Park Avenue, New York 16, N. Y., for information on
schools of nursing.
Conditions of college nurse training.—In most of the degree pro­
grams, the student makes cash payments for part or all of her main­
tenance. The cost of the degree program therefore is higher than the
52

hospital school course because of the longer course and the added main­
tenance cost, especially during the nonclinical years (72).
The nurse who goes to college may find that her studies continue into
the summer sessions, for she is carrying, in effect, two types of train­
ing: her basic college work and her nurse education. Her vacations
will, as a rule, be limited to 1 month in summer, 7 days at Christmas,
and a few days at Easter. At the same time, she will have the satisfac­
tion of knowing that she is using her tiihe most effectively for prep­
aration in the kind of training that will virtually double her job oppor­
tunities over those of the hospital-trained nurse or the average liberal
arts student in college.
Advanced Degrees in Nursing
In addition to baccalaureate courses for nurses, colleges and univer­
sities offer advanced courses leading toward a master’s degree or a
doctorate in the nursing field. These graduate training courses offer
a student professional competence beyond that of the average profes­
sional nurse. They also prepare the student for new types of work
which are developing in the nursing field as well as for related work
in specialized positions held by nurses. The first advanced university
program for nurses was established 50 years ago at Teachers College,
Columbia University (33).
In 1951, 113 universities and colleges were reported to be offering
programs in advanced nursing education to 12,022 students of whom
7,959 were part-time students and 2,148 G. I. students, provided for
under the Servicemen’s Readjustment Act of 1944 (71). The pro­
grams included the bachelor’s and master’s degree and the doctor of
philosophy and doctor of education degrees for administrators, super­
visors, and teachers. With a typical tuition cost of $785 for a mas­
ter’s degree program, most nurses prefer to undertake such study on
a part-time basis rather than face the difficulty of foregoing their
salaries for 1 year and at the same time meeting tuition and mainte­
nance costs in addition. On the other hand, fellowships for graduate
work are available to nurses in many areas. Graduate courses in­
clude pediatric, psychiatric, tuberculosis, and cancer nursing and phys­
ical rehabilitation, as well as many other clinical specialties and
management and teaching theory and practice. The number of grad­
uate nurses who receive the bachelor’s or master’s degree in any one
year is relatively small—2,300 in 1951 (7, p. 68).
In 1950, 33 universities were equipped to grant the doctoral degree
to nurses. Fifty nurses were working for the doctorate in 8 schools,
37 of them on problems of significance in the nursing field, and 22 had
already obtained the doctoral degree. This provides evidence of a
movement toward raising the scholastic qualifications of nurses in
comparison with the members of other professions (22).
53

Training Opportunities in the Commissioned Nurse Corps
In the Army, Navy, and Air Force hospitals in-service educational
programs are carried on within the hospitals to improve the quality
of the staff nurse’s performance, and many opportunities are provided,
in addition, for formal graduate study or improvement and supple­
mentation of nursing skills.
In an Army hospital, before a nurse is assigned to extended active
duty, she is given a 6- or 8-weeks’ indoctrination course at the medical
field service school at Fort Sam Houston, Tex., to learn the function­
ing of military hospitals, to obtain an understanding of military medi­
cine as it is currently practiced, and to study world-wide health con­
ditions which may affect the welfare of the American troops. The
course includes 61 hours in administration, 24 hours in ward manage­
ment and administration, 28 hours in orientation to military, medical,
dental, surgical, and neuropsychiatric subjects, 32 hours of preventive
medicine, 35 hours of logistics, tactics, and techniques, and 60 hours of
military training including 5 hours on defense against chemical war­
fare. Similar courses are given by the Navy and Air Force.
All of the military services encourage nurses to take advanced train­
ing in colleges and universities. Regular Army nurses on extended
active duty, on a selective basis, are permitted to take university train­
ing leading toward a degree. Upon completion of the training, the
nurse officer should be able to qualify for a key position in teaching,
supervision, or administration. Courses are offered each year in
(a) anesthesiology lasting 12 months in a military or civilian institu­
tion, (b) operating room techniques and management lasting 6 months
in a military hospital, and (c) hospital and nursing administration.
Some universities will count these courses toward degree credit. The
anesthesiology course qualifies the student for national board examina­
tions and ultimate membership in the American Association of Nurse
Anesthetists. A psychiatric nursing program, one of the outstanding
courses of its kind in the country, is also available to Army nurses.
In the Navy Nurse Corps, and the Air Force, when the need arises
for specialized workers, qualified nurses may be sent to college with all
expenses paid. While in college, the nurse draws full pay as an officer.
In addition, nurses are encouraged to take extension courses when off
duty at nearby universities and the policy is followed of not moving
the student to another location until current courses are completed.
Special Training for Public Health Nursing
For many positions in public health, an academic degree is required.
Otherwise it is recommended that nurses entering the public health
service have a year’s program of study in a university.
In the fall of 1951, 37 programs of study were offered for the prep­
aration of graduate nurses in public health nursing in the country;
54

90 nurses were granted master’s degrees in public health nursing in
that year, according to the National League for Nursing (7, p. 70).
Specializations include programs in industrial, school, tuberculosis,
maternity, orthopedic, mental hygiene, supervisory, and other nurs­
ing fields. The United States Public Health Service reports that, of
25,217 public health nurses employed as of January 1, 1952, how­
ever, 30.6 percent had no general college education, 46.8 percent had
some college work but no collegiate degree, and 22.6 percent had one
or more degrees (7, p. 28). (The appendix gives a list of schools
which prepare students for public health nursing.)
For illustration, in the Bureau of Public Health Nursing in the
District of Columbia Health Department, beginners (trainees) must
be graduate nurses with some public health field experience but they
are encouraged to continue with their education and obtain a bache­
lor’s or a master’s degree after they become members of the staff.
Many work part time at their college courses when they are off duty,
and others take educational leave to attend classes full time. As of
June 1952, 12 of the 130 staff nurses on the District of Columbia staff
had earned the master’s degree and 17 were studying for the degree.
Of the 68 nurses at the trainee level, 30 were taking part-time work
leading toward a degree, most of them at a university in the District.
During the year ended June 1952, two staff nurses obtained the bach­
elor’s degree and another was on leave preparing for her master’s
degree in pediatrics.
Scholarships, Stipends, and Loans
More than $3,300,000 was provided by nursing schools to assist stu­
dents in 1947-48. Of this amount, 78 percent was for stipends, 16
percent for scholarships, and 6 percent for loans. The average was
slightly more than $150 for each type of aid per student (72).
Many hospitals provide scholarships for undergraduate nurses—
some on a competitive basis without regard for the need and others
as grants-in-aid to needy students of superior achievement.
Student loans are also available at many schools, and these may
be repaid with or without interest charges. The practice about loans
varies and some have set dates for repayment. Some hospitals which
provide loans require the recipient and her parents to sign an agree­
ment to repay the loan with interest if the student withdraws or is
dismissed for any reason except illness.
Hospitals occasionally make arrangements to help needy students
earn their way through school by giving service in the institution.
Such a work-study plan may take the student a little longer than the
average to complete her training, but it also adds to her experience.
Under the National Mental Health Act, the United States Public
Health Service provides a limited number of training stipends, rang­
ing in amount from $1,600 to $2,400 a year, for graduate nurses to
55

study psychiatric nursing. These grants may be made directly to the
university schools of nursing, which select students to receive the
stipends. The Public Health Service also offers some research schol­
arships in mental health fields. The educational programs vary de­
pending upon whether the student plans to be a psychiatric nurse
or a mental health consultant in public health nursing. Preparation
includes graduation from a recognized school of nursing and 1 to 3
years of advanced study in a university with supervised experience
in clinics, hospitals, or public health agencies. In addition, scholar­
ships are frequently available from universities and through funds
allocated by the Federal Government to State health departments to
prepare nurses for administrative or supervisory positions, to be
consultants in various branches of mental health, or to take advanced
work in public health nursing (66). (A list of institutions offering
stipends for graduate work in psychiatric nursing is given in the
appendix.)
For Indian girls there are nursing scholarships available through
several agencies. The Bureau of Indian Affairs in the Department of
the Interior has some funds for this purpose. Organizations such as
the Colonial Dames, the Daughters of the American Revolution, and
the Illinois Federation of Women’s Clubs offer scholarships. Infor­
mation concerning nursing scholarships for Indian girls may be ob­
tained from the Bureau of Indian Affairs.
Under the Social Security Act funds are provided through the
Children’s Bureau for the education of nurses who are interested in
specializing in the obstetric and pediatric fields. Nurses can work
for a time as staff or general duty nurses, then take up training at a
college or university. Some specialize in maternity nursing; others
in the crippled children’s field. After the completion of their train­
ing, the nurses are expected to give service to compensate for the ex­
pense of their advanced education.
Various kinds of scholarships, which may be used for the study of
nursing, are available through civic and professional organizations,
women’s clubs, and business groups. Nurse candidates may obtain
scholarship information through school counselors or by writing to the
State nurses’ association or the State league for nursing.
V.—CONDITIONS OF EMPLOYMENT
Earnings
Nurses historically have been underpaid. The nineteenth century
nurse was often regarded as a kind of missionary, a dedicated person
who devoted herself to a life of service without regard for the eco­
nomic rewards. There is no doubt that nursing today is still a career
of service, and along with other women’s occupations which are di­
rected toward aiding people—like social work and teaching—the eco­
56

nomic advantages have not kept pace with professional requirement,
nor with the gains made for women workers in many industrial jobs.
Because the salary range for many professional and semiprofes­
sional jobs has become one of the most urgent employment problems
for women at the present time, there is good reason to anticipate more
interest in, and steps toward, the improvement of nurses’ earnings,
along with the earnings of other career-trained women.
The American Nurses’ Association has taken a positive stand for
the upgrading of nurses’ salaries and is constantly working, through
the economic security program, to improve the employment conditions
of registered nurses. This program for helping nurses to become
more effective and secure as members of their profession, utilizes
group techniques including collective bargaining, and supports de­
sirable labor legislation which affects nurses. The current shortage
of nurses, which promises to continue for perhaps a decade, has helped
to call the attention of the public to inequities in professional nurse
earnings, and in some areas, and for some jobs, demand alone has
pushed nurse salaries upward.
Many factors enter into the problem of standardizing and upgrading
salaries for professional nurse jobs: the wide range of jobs; the differ­
ences in training and experience requirements for similar jobs; the
fact that job content and the professional and practical nursing func­
tions are in a period of change; the revisions in the field of nurse edu­
cation ; difficulties in obtaining accurate salary data among a multitude
of employers in a time of job shifts and changes.
Many of the same factors which complicate the adjustment of
nurse salary inequities are, at the same time, behind the salary gains
which have been made to date: If the professional nurse function is
established as a supervisory function in a nursing team, it is likely to
bring about an upgrading in the professional nurse salary; when a
nurse job is set up to include college training, it usually carries a com­
parable pay differential.
The highest paying jobs in the nursing field, are, as previously in­
dicated (see “The Outlook,” page 26), in the administrative posts at
various levels; in teaching jobs, especially in the collegiate schools;
in highly specialized fields which require additional training, such as
anesthesiology; and in career combination jobs which demand both
nursing and another field of work, such as editorial work.
Earnings from private duty nursing vary widely according to the
locality and the current demand for nurses. Staff jobs for generalduty nurses in hospitals are generally higher paid in Federal employ­
ment, both civilian and military, than in private hospitals, except some
of the large city institutions. An employer like the Federal Govern­
ment has the advantage over small employers in being able to stand57

ardize requirements and salaries. Nurses in the military corps are
paid slightly more than those under Federal civil service (7).
It has been very difficult, over a period of years, to obtain accurate
salary data for professional nurse jobs. The discussions which follow
concerning salaries for certain classes of jobs are subject to change,
depending, to a great degree, upon the availability of new data on nurse
income, and also upon continuous changes in the jobs. Nevertheless,
such data as could be obtained are presented.
Private duty nurses.—The private-duty nurse in a home or hospital
generally charges a daily rate. The most usual rate in 1949 was $10
for 8 hours of work, with a differential (increase) for night or evening
care, and a premium for psychiatric or contagious cases (4-6). How­
ever, daily rates may range from a low of $8 to a maximum of $14 or
even higher for 8 hours of work.
Many people have gained the impression that because the cost of
24-hour nursing care in periods of serious illness seems prohibitive
when added to other medical expenses, private-duty nurses earn large
incomes. It is true that the nurse who is on private duty, and there­
fore self-employed, may have higher daily earnings, when working,
than a general-duty nurse, but on the other hand she receives no paid
vacation or sick leave and lacks the economic security of the staff nurse.
Staff nurses.—The average starting salary for general-duty nurses in
hospitals (except Federal) throughout the country was found by the
American Hospital Association to be $233 a month in 1952, an increase
of $9 a month over the previous year.
In reporting average salaries for staff nurses, the American Hospital
Association included the value of maintenance provided in the cash
average to make the monetary returns comparable. Maintenance for
the month was computed as follows: Single room, $25; double room,
$18.50; one meal a day, $14.50; two meals a day, $29; three meals,
$43.50; and professional laundry, $4.50. At this rate, the highest
possible amount allowed for full maintenance would be $73. The
highest starting salaries were $259, paid in tuberculosis hospitals.
Psychiatric hospitals averaged $256. A relatively high average sal­
ary, $259, was noted for nurses in general hospitals with more than
1,000 beds {4).
Extra pay for general-duty nurses on the evening shift was reported
by the American Hospital Association in 57.7 percent of all hospitals
and for the night shift in 62.6 percent of hospitals. This practice was
most prevalent in the Pacific Coast and East North Central regions.
About three-fourths of the hospitals on the Pacific Coast paid this
differential. Automatic salary increases were given in 85 percent of
the Pacific region hospitals but only in 70 percent of hospitals country­
wide. Overtime payment in cash was made by 50.6 percent of all
hospitals. Complete maintenance is less prevalent now than in the
58

past: 38.8 percent of the South Atlantic hospitals, but only 16 percent
of all hospitals and 2.9 percent of those in the Pacific States provided
complete maintenance in 1952 (4). Specialization of any type usually
commands higher salaries.
A report on the salaries of general-duty nurses in 10 hospitals in the
District of Columbia in 1952 showed that the average starting salary
in private hospitals (nongovernmental) ranged from $215 to $235 per
month and for governmental hospitals, city and Federal, the beginners’
range was from $288 to $350 a month. In addition, meals and laundry
for uniforms were provided in 4 of the 10 hospitals. Vacations and
sick leave averaged 12 days as a minimum and 5 to 7 holidays per year
were permitted in nongovernmental hospitals. Rotating shifts were
a requirement in all of these hospitals {25).
The beginning rate paid in the Federal Government for staff nurses
in 1952 was $3,410 in the Indian Service, in Federal hospitals in the
Washington, D. C. area, and in the Panama Canal Zone. In the In­
dian Service, where quarters are furnished, the sum of $180 to $300
per year is deducted from the annual salary and where subsistence
is provided an additional deduction of $300 is made. At some sta­
tions, employees furnish their own board on a prorated basis. In
Alaska, the nurse is permitted a 25 percent differential, making the
entrance salary $4,262.50 per annum. The beginning salary in the
Veterans’ Administration and the Tennessee Valley authority is $3,740.
Public health nurses.—Public health nurses in staff positions were
reported in 1951 to have a range of salaries from $1,700 to $5,800.
A survey of public health nursing in 1952 indicated that median
salaries in public health agencies were from $2,280 to $2,899; in city
and county health units, $3,000 to $3,099; and in local boards of edu­
cation $3,500 to $3,599 {69). In the Federal Government and in
some hospitals in the District of Columbia, the beginning rate for
public health nurses was $4,205, as indicated in the appendix. In­
creases based on length of service are also given.
Office nurses.—The salaries of office nurses tend to vary greatly
depending upon the decision of the employer. A study of 250 office
nurses in an eastern city in 1952 indicated a range of salaries from
$90 to $405 a month with a median salary of $250. Besides nurse
training, these office workers were frequently required to have addi­
tional preparation, such as skill in stenography, typing, bookkeeping,
or laboratory techniques {25).
Industrial nurses.—A wage survey made by the Bureau of Labor Sta­
tistics of the United States Department of Labor in November 1952
showed that the average annual earnings of industrial nurses in
cities exceeding 1,000,000 in population ranged from $3,042 to $3,666;
in the smaller communities of less than 500,000 the range was $2,782
59

IIPI—1

Figure 9-—Industrial nurses treat employees in first-aid room of oil
refinery
lo $3,666. Another survey of 53 industrial nurses in three medium­
sized cities in upper New York State made in March 1952 indicated
average weekly earnings of $63.50 for a 39^-hour week. Salaries
of these nurses apparently were comparable to the amounts paid to
other women workers, because 49 women doing other types of work
in the same companies, and working the same number of hours per
week had average weekly earnings of $63 (58). In April 1952 the
average weekly earnings for 241 registered industrial nurses in a
large eastern city were found to be $59.50 for a 39-hour week (60)
and another survey made in March of the same year in a large mid­
western city for 733 industrial nurses working a 40-hour week showed
average weekly earnings of $64.50 (59).
Nurse officers.—The commissioned staff nurses in Army, Navy, and
Air Force military hospitals and in the United States Public Health
Service begin as second lieutenants or ensigns with a total monthly
pay of $315.75 for those without dependents and $330.75 for those
with dependents. This includes base pay of $213.75, rental allowance
of $60, and the subsistence allowance of $42 per month. If nurse
officers live in quarters provided for them, deductions are made. In
addition to the regular pay in the Air Force, flight nurses receive
60

extra payments of $100 to $200 per month depending upon their
grade.
Federal foreign service.—For civilian nurses in the Federal service
on overseas assignments, the base pay is frequently $3,410 a year and
higher, and in some instances, an additional allowance up to 25 per­
cent of the base pay is given. Other benefits are the same as for other
Federal employees in the country except that in some cases additional
travel leave is provided and provisions for accruing leave may vary

m.
Administrators and consultants.—For executives and administrators
with ability and long experience salaries may reach the amount of
$10,000 a year. The highest nursing salaries reported in private and
in State and local public institutions were $5,400 for administrators.
The top salary for directors of nursing, directors of schools of nurs­
ing and assistant directors in the Federal Government is $8,600
and in the Armed Forces it is still higher, reaching $10,143 after 30
years of service. In public health nursing, some instructors and di­
rectors are paid up to $8,000 in civilian institutions and as high as
$8,600 in the Federal Government as consultants (7).
Part-time rates.—A study in 10 cities made by the Women’s Bureau
in 1950 showed that pay for nurses in part-time work was on an
hourly basis. The most common hourly rates paid in these areas were
$1 to $1.25 (62). The most usual workweek for these part-time
workers was 24 hours.

Hours
The average workweek for general duty nurses in 1952 was 43 hours.
The Pacific Coast area has an average of 40 hours but the Southern
States have an average workweek greater than the national average.
Hospitals providing long-term custodial care, in which the workweek
appears to be longer than in other types of institutions, probably
increase the average (4-).
In private hospitals in the District of Columbia, the 44-hour week
predominated; one hospital had 48 hours and one, 40 hours (25).
Hours for 250 nurses in doctors’ offices in the District of Columbia,
according to a survey taken in 1952, varied from less than 40 hours
for 50 nurses to 40 hours for 110 nurses and more than 40 hours for
53 nurses. Those with longer hours were paid higher salaries. The
median salary for those with less than 40 hours was $210 a month and
for those working 40 hours, or more, the median was $250. Twentythree of these office nurses revealed that most of them had worked as
private duty nurses or in hospitals prior to their present position.
On the average they had graduated 18*4 years previously from a
school of nursing and had been in their present jobs 6y2 years.
61

Seventeen stated that they preferred office work because of the better
hours and better working conditions (25).
The 40-hour week is becoming standard for nurses although many
still work longer hours. A report from the American Nurses’ Asso­
ciation in 1951, indicated that 38 percent have a 40-hour week. The
shorter week was found to improve morale and efficiency and in many
instances helped to ease the nurse shortage. The size of the staff
and the quality of care frequently increased in hospitals where the
40-hour week was installed because nurses who had resigned were
willing to return; inactive married nurses came back to work because
they could manage their household duties with 2 free days a week.
It has been found by experience that nurses prefer days off to over­
time pay. Some hospitals over a 3-week period give a “long week
end” of 4 days with 2 days off 7 days later (35). In one eastern visit­
ing nurse association, the 40-hour workweek is maintained, but onehalf of the staff works on alternate week ends. To compensate, the
nurses are off duty on a designated week day from Tuesday to Friday
inclusive. Work on holidays is voluntary with compensatory time
provided (23).
Nurses in the Federal Government are on a 40-hour week. In
some agencies they are given payment for overtime and a differential
for night work. Ordinarily they do not have split shifts, that is,
more than 1 hour off duty in the middle of the daily working period.
Variable hours for nurses are not necessarily considered an unfavor­
able aspect of the work as many nurses prefer a flexible schedule of
work.
"Fringe” Benefits
General.—All Federal, most State, and many city health depart­
ments and private agencies have merit systems with job security pro­
grams including retirement benefits, vacations with pay, sick leave
with pay, and plans for advancement (68). Officer nurses employed
in the Army, Navy, and Air Force are provided with complete health
protection including physical check-ups, medical, dental, and surgical
care, hospitalization, and leave for convalescence without loss of pay.
They also receive disability benefits, a $10,000 indemnity life insur­
ance policy, and death benefits. Allowance of $250 for uniforms is
given upon appointment and commissaries and base exchanges pro­
vide articles at approximate cost. A survey of 784 public health nurs­
ing services indicated that 88 percent had retirement plans, mostly
governmental plans, and 79 percent had some type of health insurance
plan (7, p. 86). Nurses in industry are entitled to all the benefits
which are provided for other employees of the company in which they
are employed.
Vacations.—In 1952, vacations with pay averaged 15 days for gen­
eral duty nurses in hospitals after 1 year of employment. The
62

averages for the New England and Middle Atlantic regions were 1
and 3 days above the national average, respectively; the Pacific Coast
and the Central States averaged 2 days less than the national average.
Most of the vacations of 28 days or more are found in the general
hospitals in the Middle Atlantic and New England States (Jf).
Social security payments and pension plans.—The Social Security
amendments authorized in August 1950, extend coverage of the oldage and survivors’ benefit system on a compulsory basis to selfemployed nurses with annual net earnings of at least $400. The tax,
levied on the first $3,600 of net earnings is set at the rate of 2*4
percent for 1951-53, and increases periodically to a maximum of 4%
percent by 1970. Employees of religious, charitable, educational, and
similar institutions may participate if the employer and two-thirds
of the employees agree. Employees of States and municipalities
may participate if employers negotiate the necessary agreements.
Those in Federal Government employment, unless already under the
existing retirement system, are included. For employed nurses, the
tax rate is 1 y2 percent on the first $3,600 earnings for the employee
and a similar amount for the employer for 1951-53. After that the
rate is increased gradually, reaching 314 percent for each in 1970 (65).
Benefits are provided for aged and dependent husbands and
widowers of insured women employees. In 1952 OASI benefits were
increased; the new minimum for a retired worker is $25 a month and
the maximum family benefit is $168.75 a month. This is a forward
step toward a more secure future for nurses.
As the social security benefits are comparatively small, the em­
ployer may provide a supplementary retirement plan for nurses in
addition to the benefit payments. It is also possible for State
Nurses’ Associations to sponsor individual retirement insurance plans
to supplement social security payments (11).
The American Hospital Association conducted a survey in 1952
to determine the proportion of hospitals having pension plans. Of
the 2,862 hospitals covered in the survey, 829 had no pension plans,
1,907 hospitals reported some type of pension plan, and 126 hospitals
did not answer the question. Of those with pensions the majority
(1,342) reported participation in the Federal Security program and
191 hospitals reported this program and some other pension plan in
addition (4).
Professional liability insurance.—Nurses are sometimes held liable for
damage to patients through mistakes, negligence, or incompetence.
The American Nurses’ Association has made professional liability
insurance available to its members on a voluntary basis. This pro­
vides legal defense and also provides damage payments (under
minimum annual premium of $10) up to $5,000 for one claim for
damages, with an annual maximum of $15,000 in claims for one nurse.
63

Licensing
The purpose of licensing is to protect the public from incompetent
practitioners. To obtain a State license a nurse must be graduated
from a school approved by the State board of nurse examiners and
must take a State board examination. All States now use the nursing
examinations developed by a national professional organization, al­
though there is no uniformity among States in the score accepted as
a passing grade. It is important therefore for a student before
beginning her training to make certain that she selects a Stateapproved school.
Approval of a school of nursing by a State board of examiners indi­
cates that it has complied with the minimum requirements established
by the State and that its graduates are eligible to take exam­
inations for registration or licensure. All State boards use a uniform
examination prepared by the National League for Nursing.
In 1951, 675,210 licenses were issued or renewed to professional
nurses in the States and Territories (excepting Alaska). However,
this does not indicate the number of active nurses, because many main­
tain multiple registration in two or more States. By endorsement
or examination a nurse may register in any State, on an individual
basis, provided that she can meet State qualifications, and most States
require regular license renewal.
The reports for 1951 showed that 629,361 licenses were renewed and
28,254 issued for the first time. Two States do not require periodic
renewals of license. Over 17,500 licenses in addition were issued
by endorsement to nurses already licensed in another State (7).
There is no doubt that licensing reform is needed because of the
unequal practices among the various States. Efficient and standard­
ized systems of licensing are required to provide properly for the free
movement of nurses from State to State in the practice of their pro­
fession, and in pursuit of their best career opportunities. Nursing
authorities all recommend that while professional and civic groups are
working out reforms and pressing toward the enactment of practical
regulations in relation to nurse licensing, it is the responsibility of
the graduate nurse to protect her own interests and safeguard the
standards of her profession by obtaining a license and by striving to
conform to the licensing regulations which exist. If she encounters
difficulties in obtaining a license, she can count on sympathetic advice
and assistance from the nurse examiners on State Boards.
VI.—PROFESSIONAL NURSE ORGANIZATIONS

The two principal professional organizations for nurses are the
American Nurses’ Association and the National League for Nursing,
whose origins date back to the 1890’s. Both maintain national head­
quarters at 2 Park Avenue in New York City.
64

A reorganization took place during 1952 among five national nurs­
ing organizations, of which four merged into the National League for
Nursing, and the fifth continued as a reconstituted American Nurses’
Association.
The American Nurses’ Association
As of December 1952, the American Nurses’ Association reported
a membership of 177,081 professional nurses, an increase of 3,879 over
the previous year (5). Nurses customarily join through their local
district nurses’ associations which maintain considerable autonomy but
subscribe to the basic principles and platform of the American Nurses’
Association. There are, in addition 53 State and Territorial nurses’
associations, and membership dues paid to the district are divided
among the district, the State organization, and the national head­
quarters.
Stated simply, the objectives of the American Nurses’ Association
are: “To foster high standards of nurse practice and to promote the
welfare of nurses through the coordinated action of organized profes­
sional nurses.” In the platform of the American Nurses’ Association
adopted in July 1952 there are 19 planks dealing with a more specific
definition of the objectives. These are grouped into three broad
categories: (a) to provide health protection for the American people;
(b) to aid nurses to become more effective and more secure members
of their profession; (c) to promote better health care for the peoples
of the world.
If a nurse is prevented, because of race, from joining the district or
State group, she may join the national organization. Meanwhile, the
American Nurses’ Association has set as its goal the ultimate removal
of the race barrier in all district and State nurses’ associations, not
only as part of its basic policy against discrimination, but also in
accord with the organization’s belief that local affiliation is needed for
full membership participation.
The official organ of the American Nurses’ Association is the
monthly magazine, American Journal of Nursing (2 Park Avenue,
New York, N. Y.), which has been published for more than 50 years.
The National League for Nursing
The National League for Nursing establishes standards and goals
for nursing service and nursing education, its two broad divisions of
program. Its work includes research and the publication of recom­
mendations for improvement and effective maintenance of organized
nursing services and nursing schools. It also provides an information
and consultant service to hospitals, nursing schools, community health
agencies, and to individuals. Membership may be individual or group
(the latter, a hospital unit or community agency, or school of nursing)
and every member is a voting member.
65

Its official magazine is Nursing Outlook, published monthly at 2
Park Avenue, New York, N. Y.
Contributions, and research grants for special studies and services,
are made annually to the National League for Nursing by the United
States Public Health Service, large private health organizations, and
various well-known foundations.
VII.—SUGGESTIONS TO THE NURSE CANDIDATE
Making the Career Choice
For those young women who are very certain that they wish to
become professional nurses, but not certain as to their precise quali­
fications for the work, there are ways by which they can obtain
information which will help them to make the decision. And for
those who are less certain that professional nursing is the career they
prefer and who need more guidance before they enter training, the
same sources of information are available.
First of all, there are certain basic requirements which the Commit­
tee on Careers in Nursing of the National League for Nursing
recommends (IS) :
Age: 18 to 35 years (17 years in some schools).
Education: High-school graduation in upper half (or upper third)
of class; some schools require or prefer one or more years of college
work. High-school courses should include: English, 4 years;
science, 3 years; mathematics, 2 years; history, 2 years; language,
2 years; also civics, sociology, economics.
Personal: Good health, accuracy, liking for work with people, integ­
rity, good judgment, imagination and sense of humor, sympathy and
understanding, kindliness, poise and resourcefulness.

It should be noted that the educational requirements are set forth
as a guide, and that many schools will accept different combinations
of subjects listed, but 4 years of high school is a basic minimum, and
there are also certain prescribed courses in science without which it
will be difficult for the student to gain admission to an approved
nursing school. Some schools, especially the collegiate, list higher
requirements than the minimum.
It is also important to observe that good health and a liking for
work with people, rather than things, or abstract ideas, are basic
requisites. As to the other qualities, they are essential for the graduate
nurse; in the young person, these qualities may not always be present,
observable, or developed to the extent necessary for a mature approach
to professional nursing until after the training period. Because the
area of personal qualifications is a difficult one for a nurse candidate
to determine for herself, the National League for Nursing, many
66

schools of nursing, and the United States Employment Service have
worked out aptitude tests to measure the combination of qualifications
likely to lead toward a successful nursing career.
Consequently, if there is any doubt concerning her aptitudes, the
young woman who believes she wishes to enter the nursing field maygo to a school of nursing in her community to discuss this problem
in an interview with some one at the admitting office. She may be
given an aptitude test at this time. Or she may go to the nearest State
Employment Service in her community and ask to take the nursing
aptitude test. If this test is not available at once, she will be advised
concerning where and when she may take it. Neither the school nor
the Employment Service will make any charge for this kind of
guidance.
If the nurse candidate registers for a school of nursing without
having taken any kind of aptitude or selection test, it is possible that
she will be required to take one, for the progressive schools of nursing
are using tests to an increasing degree in order to eliminate candidates
who are not likely to succeed. It is probable, however, that the student
who meets most of the qualifications listed above for education and
personal characteristics will find the test easy, even enjoyable, and pass
it readily. No preparation or study is required for an aptitude or
selection test, and such examinations have been designed for the
benefit and guidance of the student as much as for the schools of
nursing.
Selecting the School of Nursing
The choice of a school is very important. Whether to attend a
degree-granting collegiate school of nursing or to seek a diploma in
nursing in a hospital school is a decision which the individual pro­
spective student must make for herself. A good school of either type
has distinctive advantages to offer. The first choice of a school, how­
ever, should be based upon the fundamental question as to whether
college work and nursing are more suitable than nurse training alone.
Young candidates for the It. N. who have the ability to take college
work are being encouraged everywhere by professional nurse and medi­
cal groups to combine it with nurse training, and there are increasing
scholarship possibilities for the student who cannot finance such an
education through her own resources.
In any case, it is wise for the prospective nursing student to obtain
a list of approved schools from the Committee on Careers in Nursing,
at 2 Park Avenue, New York 16, N. Y., and also to write to several
schools before deciding upon one. Following is a list of questions
to be used as a guide in selecting a school. The answers can be ob­
tained from the school catalog or by writing to the director of the
nursing school.
67

1. Can graduates of this particular school (use name) take examinations
offered by the State Board of Nurse Examiners?
2. Is the school affiliated with a hospital with at least 100, preferably 200,
daily patients?
3. Is the hospital approved by the American College of Surgeons?
4. How many hours per week are required for combined class work, nursing
practice, and study?
5. During the period of clinical experience, how much night work is required
of students?
6. What are the tuition costs?
7. What are the students’ living conditions, recreational facilities, and
social activities?

The student should not enter training in a school which is unable
to reply affirmatively to the first three questions. In addition to the
seven questions listed, the student may add her own detailed inquiries
about the possibilities of scholarships, financial aid or loans, if she is
interested.
The prospective nurse who plans to undertake collegiate training
should focus attention on the educational program offered and not
be too eager to accept any degree regardless of its worth. She should
seek guidance from competent sources such as professional nurse or­
ganizations concerning the scholastic standing of a degree-granting
school.
Some graduate nurses take extension or correspondence courses or
attend a 6-week summer session during their vacations to accumulate
college credits, and various combinations of college work with nurse
training are available.
VIII.—INFORMATION FOR THE GRADUATE NURSE
Special Training
Some nurses know during training that they want to specialize in
a particular aspect of nursing care, or that they wish to become execu­
tive nurses, educators, or apply their training to a special field. Others
prefer to go into general duty nursing for a year or two until they can
decide, and frequently, during work experience, they become interested
in specialized nursing. Good sources of information about special
training for graduate nurses are the professional nursing organiza­
tions, and a nurse may inquire about opportunities and requirements
for advanced training through a State or District group of the Amer­
ican Nurses’ Association, or from the national headquarters. Or, she
may discuss advanced training possibilities with the executive nursing
staff at the hospital or institution where she works. As with under­
graduates, there are financial aid possibilities for graduates to help
in providing advanced training in academic institutions. Usually,
scholarships or fellowships are given on the basis of scholastic achieve­
ment, personal characteristics, and aptitude. It is possible, however,
68

Figure 10.—A nurse anesthetist.

for a graduate nurse to obtain many kinds of specialized training
through her work experience, and without taking time out to go hack
to school on a full-time basis.
Insurance
Two special kinds of insurance are needed by nurses for their own
protection. To protect themselves against claims made by patients
for injuries resulting from mistakes, negligence, or incompetence on
the part of the nurse, they need professional liability insurance (see
section Y).
To provide benefits in case the nurse herself is injured on the job,
a different type of insurance is needed, such as that provided under
State workmen’s compensation laws. As workmen’s compensation
coverage varies from State to State, a nurse entering a new job should
make it her business to find out whether she is covered; for example, in
some States staff nurses may be covered but not nurse administra69

tors. In cases not clearly covered by the workmen’s compensation
system, injuries received on the job are subject to legal rulings, and
the employer or the institution may not be considered liable in certain
situations. The opinions of the State attorney general may be the
basis of policy in a particular State. State nurses’ associations are
able at times to give counsel on legal questions.
Organization Membership
The active nurse will find it important to keep in touch with a pro­
fessional nursing organization, but merely joining is not especially
rewarding. Officials of the organizations urge members to attend
meetings, keep informed of current issues, discuss and vote for action
to raise the status of the profession, and serve on committees at the
State and local levels. The nurse can keep informed on new trends
through her organization and professional journals. These activi­
ties enlarge the field of personal interests, bring new contacts, and
opportunities for congenial social and recreational activities.
Seeking Employment
With the general outlook as promising as it is for nursing in the
coming years, the graduate nurse will have little trouble finding a job.
On the contrary, she may find it difficult to select the job appropriate
to her immediate needs and interests if a wide choice of position va­
cancies is offered to her. To assist her in making the job choice there
are professional nurse registry offices readily available in most sections
of the country, and she may address an application to one if she is not
able to call for a personal interview. The interview is, of course,
preferable, for the satisfaction of both the job applicant and the place­
ment counselor.
It should not be necessary to advise the graduate nurse that her best
opportunities in registering for job placement are with the offices
which are affiliated with a professional nurse group, or which are
sponsored or approved by such a group.
In some sections of the country there are State employment offices
which are prepared to give a nurse applicant a professional place­
ment service. The largest one of this kind has offices in New York
City supervised by the New York State Employment Service and is
guided by an advisory council of competent professional nursing
and medical personnel.5 There is no fee charged for nurse placement
or counseling service. Although most job openings handled by this
office are in the area of New York City, an increasing number of place­
ments each year have been made in other parts of the country. In
1952, the New York State Employment Service office for professional
nurses, practical nurses, and related nursing workers made some place‘ Address: The Nurse and Medical Placement Center, New York State Employment
Service, 136 East 57th Street, New York 22, N. Y.

70

merits in other States. Of out-of-town placements for professional
nurses 13 percent were outside of the country. In 1952, a total of
18,992 placements were made for professional nurses. Employers
served by the office included private patients, hospitals, institutions,
schools of nursing, public health agencies, boards of education, busi­
ness and industrial firms, camps, physicians, medical schools, labora­
tories, and Government agencies.

71

APPENDIX
1. —Minimum Requirements for a Beginning Federal Civil Service Posi­
tion as a Staff Nurse for Duty in Washington, D. C., and Vicinity and
in the Panama Canal Zone
(As taken from the Civil Service Announcement No. 267, unassembled ; issued January 16,
1951, no closing date.)

Citizenship in the United States.
Age: Under 35 years of age for positions in the Panama Canal Service. For
other Federal agencies under 62. These age requirements are waived up to
the age of 62 for Panama Canal Service and for other Federal agencies with­
out limitation for those with veteran preference.
Physically capable of performing the duties of the position. Passing of a physi­
cal examination is necessary for appointment. Good vision in one eye is
required. In most instances, an amputation of a leg or foot will not disqualify
an applicant for appointment although it may be necessary that this-con­
dition be compensated by the use of satisfactory prosthesis.
Education and experience: Applicants must have successfully completed one of
the following:
1. A full 3-year course in an accredited school of nursing which included
organized instruction and broad clinical practice in medical, surgical, pedi­
atric, and obstetric nursing; or
2. A full 2-year course in residence in an accredited school of nursing,
plus additional appropriate nursing experience or pertinent education.
This combination must have included instruction and broad clinical practices
in medical, surgical, pediatric, and obstetric nursing and must total 3 years
of education and experience. The total combination must have given the
applicant a professional knowledge comparable to that which would have
been acquired through successful completion of a 3-year course in an ac­
credited school of nursing.
Male nurses will not be required to have clinical practice in obstetrics and
pediatric nursing if the same number of hours of organized instruction and
months of clinical practice in psychiatric nursing and/or genito urinary
nursing have been successfully completed.
Note—The positions to be filled from this examination are in hospitals in
Washington, D. C., and vicinity and in the Panama Canal Service in the Panama
Canal Zone. Most of the positions in the Washington area are in St. Elizabeths
Hospital (psychiatric) and in Freedmen’s Hospital. However, some positions
in the Washington area may be filled in other hospitals, such as Army, Navy,
Air Force, etc., as the need arises. The majority of positions are general duty
nurse at grade GS-5 with a beginning salary of $3,410. No written test is re­
quired. Applicants’ qualifications are rated from a review of their education,
training, and experience. This examination also included positions for psychi­
atric head nurses at St. Elizabeths Hospital at a GS-7 grade with a beginning
rate of $4,205.

2. —Minimum Requirements for a Beginning Federal Civil Service Posi­
tion as a Staff Nurse for Duty in the Indian Service of the United States
Department of the Interior
(As taken from the Civil Service Announcement No. 211, unassembled ; issued February 8,
1950, no closing date.)

Citizenship in the United States.
Age: Under 40 years of age except for those entitled to veteran preference.
Physically capable of performing the duties of the position. Passing of a physi­
cal examination is necessary for appointment.

72

Education and experience:
Applicants must have successfully completed one of the following:
1. A full 3-year course in residence in an accredited school of nursing
which included organized instruction and broad clinical practice in medical,
surgical, pediatric, and obstetric nursing; or
2. A full 2-year course in residence in an accredited school of nursing, plus
additional appropriate nursing experience or pertinent education, including
instruction and broad clinical practice in medical, surgical, pediatric, and
obstetric nursing, and must total 3 years of education and experience with a
total professional knowledge comparable to that acquired through successful
completion of a 3-year course in an accredited school of nursing. Part-time
or unpaid experience will be credited on the basis of time actually spent in
appropriate activities.
Note.—The positions to be filled from this examination are in hospital services
of the Indian Service located in the United States, west of the Mississippi, and
in Alaska. The beginning salary is $3,410 for a GS-5 position. No written test
is required. Applicants’ qualifications are rated from a review of their edu­
cation, training, and experience.

3.—Minimum Requirements for a Beginning Federal Civil Service Posi­
tion as Public Health Nurse for Duty in the Bureau of Indian Affairs
(As taken from the Civil Service Announcement No. 243, unassembled; issued August 8,
1&50, no closing date.)

Citizenship in the United States.
Age: Under 40 years of age except for those entitled to veteran preference.
Physically capable of performing the duties of the position. Passing of a physi­
cal examination is necessary for appointment.
Education and Experience:
1. Applicants must have successfully completed one of the following:
A. A full 3-year course in residence in an approved school of nursing,
which has included organized instruction and broad clinical practice in
medical, surgical, pediatric, and obstetric nursing; or
B. A full 2-year course, in residence in an approved school of nursing,
plus 1 year of appropriate nursing experience or pertinent education.
These 3 years of education or education and experience must have
included instruction and broad clinical practice in medical, surgical,
pediatric, and obstetric nursing and must have given the applicant a
technical knowledge of these fields comparable to that which would
have been acquired through the completion of the 3-year course described
in A above.
2. Included in the above requirements or supplemental to them, the appli­
cant must show the successful completion of a minimum of 30 semester hours
in a program of study in public health nursing, meeting the requirements of
the National Organization for Public Health Nursing and approved by the
National Nursing Accrediting Service.
3. The applicant must have had 1 year of experience in a generalized pub­
lic health nursing program in a rural or urban health agency which provides
a community with public health nursing service in which family health work
is emphasized.
Note.—The positions to be filled from this examination are in hospitals of the
Bureau of Indian Service located principally on reservations west of the Mis­
sissippi River and in Alaska. The beginning salary is $4,205 for a GS-7 position.
No written test is required as applicants’ qualifications are rated from a review
of their education, training, and experience.

73

4.—-Minimum Requirements for a Beginning Federal Civil Service Posi­
tion as Staff Nurse, General Duty Nurse, Ward Nurse, and Other
Positions Requiring Similar Qualifications in Various Federal
Agencies
(As taken from the Civil Service Announcement No. 4-9 (1952), unassembled; issued
April 14, 1952, no closing date.)

Citizenship in the United States (or applicant must owe allegiance to the United
States).
Age: From 18 to 62 years. Age limits are waived tor persons with veterans’
preference.
Physically capable of performing the duties of the position. Good vision in one
eye and the ability to read fine calibrations (glasses permitted), to distinguish
shades of color, and to hear the whispered voice are required. An amputation
of a limb will not disqualify an applicant although it may be necessary that
this condition be compensated by use of satisfactory prothesis. Passing of
a physical examination is necessary for appointment.
Education and experience:
Applicants must have successfully completed one of the following:
1. A full 3-year course in residence in an approved school of nursing which
includes organized instruction and broad clinical practice in medical, surgi­
cal, pediatric, and obstetric nursing; or
2. A full 2-year course in residence in an approved school of nursing, plus
additional appropriate nursing experience or pertinent education, which,
when combined with the 2-year course in nursing, will total 3 years of
education and experience comparable to that acquired through the successful
completion of a 3-year course in an approved school of nursing.
Male nurses' may substitute the same number of hours of instruction and
practice in psychiatric and/or genito-urinary nursing for clinical practice
in obstetric and pediatric nursing.
Registration in a State or the District of Columbia at the time of the appoint­
ment is required.
Note. The positions to be filled from this examination are in various Federal
agencies in the States of Maryland (except for the counties of Prince Georges
and Montgomery), West Virginia, North Carolina, and Virginia (except Arling­
ton County and the City of Alexandria). Positions in the U. S. Public Health
Service will be filled from this' register but not positions in the Indian Service.
The positions are at Grade GS-5 with a beginning salary of $3,410. No written
test is required. Applicants’ qualifications are rated from a review of their
education, training, and experience. This examination also includes positions
for head nurses in the same Federal agencies at a GS-7 grade with a beginning
rate of $4,205.

5.—Minimum Requirements for Professional Nurses at the Clinical
Center, National Institutes of Health, Bethesda, Md.
(Examination opened April 21, 1953, after this bulletin was in press; no closing
date.)
Open to citizens, both men and women; foreign-trained nurses must show that
their education and experience meet the requirements; no maximum age limit.
Entrance salaries: $3,410 (GS-5) for general staff nurses; $4,205 (GS-7) to
$5,940 (GS-11) for nurses with clinical specialties as follows: Arthritis and
metabolic disease; cancer; infections and tropical disease; cardiovascular
disease; neurological diseases and blindness; psychiatry; pediatrics; operating
room; outpatient department; nursing service administration (grade GS-11
only) ; $5,940 (GS-11) for nurse supervisors.

74

Forms can be obtained from Board of U. S. Civil Service Examiners, National
Institutes of Health, Bethesda 14, Md., or in tirst- and second-class post offices
where this notice is posted ; or from U. S. Civil Service Commission, Washing­
ton 25, D. C.

6. —Institutions Offering Public Health Service Stipends for Advanced
Training in Psychiatric Nursing Under the National Mental Health
Act, for the Academic Year 1950-51
Boston University, Boston, Mass.
University of California, San Francisco, Calif.
Catholic University of America, Washington, D. C.
University of Colorado, Boulder, Colo.
Columbia University Teachers College, New York, N. Y.
University of Connecticut, Storrs, Conn.
Duke University, Durham, N. C.
Johns Hopkins University, Baltimore, Md.
Louisiana State University, New Orleans, La.
University of Minnesota, Minneapolis, Minn.
University of Pennsylvania, Philadelphia, Pa.
University of Pittsburgh, Pittsburgh, Pa.
University of Washington, Seattle, Wash.
Washington University, St. Louis, Mo.
Yale University, New Haven, Conn.

Note.—All applications should be directed to the dean or director of the
school in which the applicant is interested.

7. —Schools of Nursing Which Offer Basic Nursing Programs to Prepare
Students for Beginning Positions in Public Health Nursing Under
Supervision
Adelphi College School of Nursing, Garden City, N. Y.
Boston University, School of Nursing, Boston, Mass.
Cornell University, New York Hospital School of Nursing, New York, N. Y.
Skidmore College, Department of Nursing, Saratoga Springs, N. Y.
University of Colorado, School of Nursing, Denver, Colo.
University of Washington, Seattle, Wash.
Vanderbilt University, Nashville, Tenn.
Wayne University, Detroit, Mich.
Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland,
Ohio.
Yale University School of Nursing, New Haven, Conn.

Note.-—If the prospective student graduates from a school whose basic pro­
gram does not give preparation for public health nursing, special work in public
health nursing must be taken before qualifying for this field.

75

--I
C\

8.—The Military Nursing Services
Requirements for reserve
commission
Age-------------Marital status
Citizenship__

The Air Force Nurse Corps

The Army Nurse Corps

The Navy Nurse Corps

21-45 years.
Married or single, no dependents
under 18.
U. S. citizen.

21-45 years.
Married or single, no dependents
under 18.
U. S. citizen.

21-40 years.
Married or single, no dependents
under 18.
Native born or naturalized more
than 10 years.
Graduation from high school and an
accredited school of nursing.

Education___

Graduation from high school and a
nursing school approved by the
surgeon general.
In at least one State or Territory
Registration
or the District of Columbia.
Commission on appoint­ Second lieutenant to major, de­
pending on age, preparation, and
ment.
experience.
("Base pay$213. 75
Base pay and allowance
Quarters ___ .
______ 1 60. 00
(for second lieutenant ^Subsistence____________
42.00
or ensign) without de­
pendents.
,
Total$315. 75
Hours of duty
40-hour week ordinarily.
30 days annually.
Vacation
lime required for proces­ 6 to 8 weeks provided all forms are
sing applications.
correctly completed.
Where to apply______ -. Acting Chief, Air Force Nurse
Corps, Office of the Surgeon
General, USAF, Washington 25,
D. C.
1 If no outside quarters are provided.

Graduation from high school and a
nursing school approved by the
surgeon general.
In at least one State or Territory I In at least one State or Territory or
or the District of Columbia.
the District of Columbia.
Second lieutenant to major, de­ Ensign to lieutenant, depending on
pending on age, preparation, and
age, preparation, and experience.
experience.
Base pay$213. 75
j Base pay$213.
75
Quarters__ ____________ 1 60. 00 j Quarters '60.
00
Subsistence___
___
42. 00 Subsistence_____________
42. 00
Total $315. 75
40-hour week ordinarily.
30 days annually.
6 to 8 weeks provided all forms are
correctly completed.
Chief Nurse of Army area or Office I
of the Surgeon General, Depart­
ment of the Army, Washington
25, D. C.

Source: American Journal ofNursing, July 1951, p. 449.

Total____________ $315. 75
40-hour week ordinarily.
30 days annually.
3 to 4 months, depending on time
required to secure transcripts, etc.
Nearest office of naval officer pro­
curement (see Official Directory.
April Journal).

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79

CREDIT FOR ILLUSTRATIONS

The illustrations appearing in this bulletin were obtained through
the courtesy of the following:
American Nurses’ Association (figs. 2, 7).
Bates College, Lewiston, Maine (fig. 8).
Harper Hospital, Detroit (cover picture) (fig. 8).
Hospital, New Bedford, Mass, (photo by Rittase) (fig. 8).
Navajo Service, Window Rock, Ariz. (photo by Snow) (fig. 2).
Newsweek, Feb. 18,1952 (photos by Wergeles) (fig. 1).
Standard Oil Co. (N. J.) (fig. 9).
United States Atomic Energy Commission (fig. 4).
United States Department of the Air Force (fig. 3).
United States Department of the Army, Surgeon General’s Office (fig. 3).
United States Department of the Navy (figs. 5, 10).
United States Public Health Service (fig. 2).

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