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Nursing History Review

Center for the Study of the History of Nursing at the University of Pennsylvania

By Diane Sussman
December 23, 1999

“Nursing is hard work—unless you love it,” a 101-year-old nurse told her great-granddaughter, a nursing student, in an interview taped for family members a year before her death in 1989.

It was the tidy summing up of a career that began when the 20-year-old orphan entered Union Hospital nursing school in Terre Haute, Ind., in 1907 and didn’t end until 50 years later when the woman, by then a wife and grandmother, retired from private duty nursing.

The woman’s experiences—from her initial pangs of self-doubt to childish moments of horseplay with interns to her growing competence—paint a fairly typical picture of what life was like for nurses at that time, said Joan E. Lynaugh, PhD, RN, FAAN, head of the Center for the Study of the History of Nursing at the University of Pennsylvania in Philadelphia, editor of Nursing History Review, and professor emeritus at the School of Nursing at Penn.

Careful training

Like most of her contemporaries, the nurse interviewed on the tapes was trained at a hospital nursing school. By the early 1920s, 1,006 of the nation’s 4,359 hospitals operated nurse training schools, according to the American Medical Dictionary. A typical hospital school of nursing in a smaller city required two years of high school along with evidence of “careful home training” and “a definite knowledge of housekeeping duties.”

“You have these young women who left home and are living with other women and working with doctors,” Lynaugh said. “Like it or not, there was a lot of fun going on. At the same time, she’s learning helpful things and learning to do the right thing.”

She learned to do the right thing as a nurse only after months of menial labor: scrubbing floors, making beds, carrying bedpans, preparing meals, and arranging trays. Only then did students progress to giving medication, recording vital signs, and other “scientific things,” as the woman called them.

Beyond the menial

Those “scientific things” meant anatomy, physiology, bacteriology, urinalysis, materia medica, gynecology, and medicinal “solutions,” as well as ethics, massage, cookery, and hygiene. “We tend to think they didn’t know that much, but it’s not true,” Lynaugh said. “What nurses knew in 1910 was quite a lot, really. They knew anatomy and about drugs—quinine, morphine, stimulants, emetics, cathartics, sedatives.”

Besides the heavy course work, usually taught in a stern authoritarian manner, students worked 12-hours shifts with time off for meals and rest. For their labor—and students made up the bulk of the nursing work force in hospitals—they received about $50 a year, room, board, and uniforms.

Once out of school, large numbers of nurses became private duty nurses. For days, weeks, or even months at a stretch—until the pneumonia or TB they had been hired to treat resolved—the nurses would single-handedly keep the patient hydrated, supervise meals, dress wounds, and clean the room and equipment. “They never left,” Lynaugh said.

Not bad for a day’s work

Compared to factory or farm work, it wasn’t a bad living for a woman, about $6 to $7 a day for 24-hour duty—provided there were no blank spaces between jobs. “If they worked steadily, they could make $1,500 a year,” Lynaugh said. “The problem was working steadily. They had to be very enterprising.”

Also unlike farm or factory life, they saw sides of life unavailable to the majority of women of their day. “It was a remarkable life for a woman,” Lynaugh said. “They travel around. And patients are exotic. People who are of other races and other social classes, people with lice, people who were violent ...”

For all the independence, the work was arduous, isolated, and potentially lethal. “They get sick; they catch things. They were afraid of TB, typhoid, and syphilis. Life before antibiotics is full of a different set of fears.”

Furthermore, they often found themselves in situations in which the distinction between nurses and nursemaids was blurred by family members, forcing them into the role of nanny or maid. “Part of a nurse’s trials and tribulations were being treated like a servant,” Lynaugh said. “Authority was a big part of the nurse’s effectiveness. She had to be able to manage people in their own environment.”

By the 1920s, nursing was in a rapid period of flux, brought on by the double shocks of World War I and the devastating influenza epidemic that killed more than 500,000 in the United States. The bread-and-butter job of 10 years earlier, private duty nursing, began to wane as more people went to hospitals to convalesce, give birth, or have surgery. In the 1930s, sulfonamides further eroded private duty nursing, curing diseases with long convalescent periods, such as pneumonia, that were the staple of the trade. The next wave, hospital and public health nursing, was coming in.

Yet despite all the advances in technology, drugs, surgical techniques, and medical understanding, nurses of today have more in common with nurses of the past than might be apparent walking past an ICU, Lynaugh maintains. “The rich experience of working with the sick in a way that’s gratifying to the nurse is a pretty constant thing,” she said. “There’s a romance to nursing that will never go away.”