How did you get into nursing? Nursing research?

I never really wanted anything else. I was a skinny kid and there was the idea that nurses had to be strong, tough women. People tried to dissuade me, but I said, "I'll show them," and that's what I did.

Penn is a research-based institution and I'd always liked history, so it was a good fit when I went for my doctorate.

It was my understanding of labor markets that when there were shortages, employers did things to attract people into the market, such as raising salaries, but that didn't seem to happen with nurses. One way to answer the questions I had regarding nurses' work was to look at our past for historical knowledge of why nurses were undervalued. That's what I did with my research.

What is your research regarding the nursing shortage about?

I just finished a study on the introduction of the eight-hour day. It was started during the Depression to give more work to nurses. If nurses worked only eight hours, hospitals could hire three nurses for a 24-hour shift rather than two. Hospitals, however, were slow to adapt and when they adopted eight-hour shifts, shortages often resulted.

I'm now seeking funding for two studies related to the eight-hour study. One area I would like to investigate is how working conditions affect nurses' participation in collective bargaining.

There may well be a relationship between nurses' desire to improve their working conditions, hospitals' resistance to improving the way nurses work and the appearance of collective bargaining activities.

I'm also interested in the phenomenon of the private-duty nurse, who was often thought of, particularly around the World War II era, as a low-cost alternative to permanent employees. Hospitals would hire private-duty nurses rather than employ full-time nurses and then if the patient census decreased, tell the nurses they were no longer needed.

Historians have said that private-duty nursing stopped in the '30s, but my research indicates private-duty nursing was a significant occupational field into the '60s. We see similarities today between private-duty nurses and the widespread use of traveling nurses as an alternative to regular employed staff.

What kind of records do you research?

I researched many private-duty registries and it's amazing what you can find. Sometimes, I think there's almost too much data for me to handle.

One time, by chance, I ran into a bystander who happened to mention that she had records from the Chicago Nurses Professional Registry, one of the largest private-duty registries in the country. I think they had been sitting in someone's basement for many years. I've looked at organizational records, hospital association records and the ANA records or commentaries of the ongoing work situation at that time.

I'm like a detective shifting through evidence trying to see what the story is and gaining insight from who did what and when.

What can we learn from the Chicago Nurses Professional Registry (1913-50)?

The thing about this registry is that it was owned and operated by nurses for nurses. Nurses were running the business of nursing. They made sure that patients got nurses as needed and they were quite successful. They were a major force in Chicago health care. This registry continued in business until the early 1980s.

The take-away lesson is that nurses can take control of their practice and be successful at it. Nurses know what to do and they get it done well.

What can we predict from looking at yesterday's nursing shortage?

There have been a lot of solutions that haven't worked and yet we keep using them.

We've tried to increase the supply; we now have 2.8 million nurses with 2.1 million or 2.2 million actually working. So, that's not the answer. We've tried to make nurses [more quickly] by shortening the time it takes to be a nurse. We've looked overseas, but the shortage is worldwide, robbing one country to supply another. It's the same old solutions over and over again.

We haven't adequately looked at nurses' working conditions. When nurses still are expressing dissatisfaction, there's room for improvement.

We need to revolutionize how nurses get to patients. There's been no change in that area since nursing started. Nurses need more autonomy in deciding how they'll do their work. Getting pulled from floor to floor or experiencing mandatory overtime are examples of things that take autonomy away from the nurses.

Nurses have a lot of creativity and hospital administrators need to let them tackle this problem.