Chapter 01: A Brief History of the Professionalization of Nursing in the United States
Friberg: Conceptual Foundations: The Bridge to Professional Nursing, 7th Edition

MULTIPLE CHOICE

	1.	Historically, women were considered the obvious choice for nursing sick patients, because:
a.	caring for others was an extension of their homemaker role.	
b.	early nurses were nuns, so the public was used to women in nursing.	
c.	men, who had education, were reluctant to try nursing.	
d.	women were often at home anyway, so caregiving was easy.	

ANS:	A
Women’s domestic role (as homemakers and mothers) was naturally associated with the caregiving required in nursing. Although religious orders did play a role in health care, it was the domestic duties of women that set the stage for their involvement in nursing. Widespread education for men and women is a fairly new phenomenon and did not play a role in the early history of nursing. Women did not care for sick or injured strangers in their homes, so being at home was irrelevant.

	2.	Florence Nightingale’s views about trained nurses were most influenced by her:
a.	experiences in wartime.	
b.	ideas about sanitation.	
c.	relationships with physicians.	
d.	view of education.	

ANS:	A
Nightingale’s experiences in wartime demonstrated to her that trained nurses were valuable in decreasing morbidity and mortality among soldiers. Nightingale had revolutionary ideas about hospital sanitation, but these are not credited with her advocacy of using trained nurses. Early trained nurses were taught to follow the directions of the physician; collegial relationships were not a part of health care practice in Nightingale’s day. Nightingale’s views of education were influenced by her opinion on the value of trained nurses, not the other way around.

	3.	A nursing instructor explains to students that the major goal of the Society of Superintendents of Training Schools for Nurses of the United States and Canada was to:
a.	improve working conditions for students.	
b.	obtain legal recognition for the profession.	
c.	raise and standardize the training of nurses.	
d.	reverse discrimination in admissions policies.	

ANS:	C
The goals of the Society of Superintendents were “to promote fellowship of members, to establish and maintain a universal standard of training, and to further the best interests of the nursing profession.” Students were expected to work in apprenticeships during their education in the hospital-based programs in existence at the time. Obtaining legal recognition for nurses was the goal of the Nurses’ Associated Alumnae of the United States and Canada, later renamed the American Nurses Association. Discrimination in nursing existed well into the civil rights era and beyond, with men and women of color routinely being banned from admission and employment.

	4.	Today’s nurse understands that legal recognition for nurses was imperative to:
a.	allow nurses to expand beyond the hospital setting.	
b.	lobby for better wages and working conditions.	
c.	protect the public from untrained nurses.	
d.	provide hospitals with accreditation requirements.	

ANS:	C
The goal of the Nurses’ Associated Alumnae of the United States and Canada (renamed the American Nurses Association in 1912) was to protect the public from untrained nurses by securing legal recognition for trained nurses. Graduate nurses predominantly worked as private duty nurses up through the early 20th century. Wages remained low, and working conditions remained long and arduous in hospitals (and seasonal for private duty nurses) until hospitals began hiring more graduate nurses in the 1930s. Hospital accreditation is a recent phenomenon, unattached to legal recognition for nurses.

	5.	Which patient would most likely have been cared for in a hospital in the 19th to early 20th century?
a.	Dying patient	
b.	Contagious patient	
c.	Homeless patient	
d.	Woman in labor	

ANS:	C
Hospitals were considered places for people who had no one else to care for them.
Most patients were cared for in their homes. A dying patient probably would have been cared for at home. A patient with a communicable illness would have probably been confined to his or her home. Women in labor typically had their children at home.

	6.	Lillian Wald’s contribution to nursing can best be described as the:
a.	creation of community health nursing.	
b.	development of college-based nursing schools.	
c.	establishment of the Navy Nurse Corps.	
d.	foundation of maternal-child nursing.	

ANS:	A
Wald responded to the changing social conditions in the late 1800s by establishing the Henry Street Settlement and Henry Street Visiting Nurse Services in response to the horrendous health conditions she witnessed in New York City. Wald was not involved in establishing college-based nursing programs. Wald was not involved in establishing the Navy Nurse Corps. Wald was not involved in establishing maternal-child nursing as a specialty, although she did care for many new mothers and their infants as part of her community nursing role.

	7.	Which event eventually led to the creation of military nursing?
a.	American Civil War	
b.	Spanish-American War	
c.	World War I	
d.	World War II	

ANS:	B
During the Spanish-American War, trained nurses cared for soldiers suffering from yellow fever. This convinced the military and Congress of the need for qualified nurses and set the stage for the eventual creation of the Army Nurse Corps in 1901 and the Navy Nurse Corps in 1908. During the Civil War, both sides wanted women to care for injured and ill soldiers, but these women were mostly untrained volunteers from the middle and upper classes. World War I occurred after the creation of the Army Nurse Corps and the Navy Nurse Corps. World War II occurred after the creation of the Army Nurse Corps and the Navy Nurse Corps.

	8.	A faculty nurse explaining the stratification in nursing roles seen today tells students that the most important event leading to this development was:
a.	desegregation in nursing.	
b.	limited nursing opportunities.	
c.	the Korean conflict.	
d.	World War II.	

ANS:	D
The United States’ involvement in World War II dramatically increased the demand for trained nurses. To help fill this need, the American Red Cross and the Office of Civilian Defense co-established a program to train nurse aides. The success of the program encouraged hospitals to use employees with various levels of skill. Desegregation in nursing did come about in the same era as stratification, but it was not instrumental in creating this differentiated practice. Nursing opportunities were increasing throughout the 20th century. Role stratification was already entrenched by the Korean conflict.

	9.	Discrimination against African-American nurses began to wane during:
a.	Kennedy’s presidency.	
b.	the civil rights era.	
c.	the Vietnam War.	
d.	World War II.	

ANS:	D
World War II saw discrimination against African Americans begin to wane with the end of segregation in the military Nurse Corps. At the end of World War II, many state nurses associations ended their discrimination in membership as well; by 1952, all state nurses associations had eliminated such discriminatory policies. Kennedy’s presidency, although known for civil rights advancements, was not when discrimination began to end. The civil rights era occurred at approximately the same time as the Kennedy era. The Vietnam War occurred at the same time as Kennedy’s presidency and civil rights era.

	10.	Between the years 1950 and 1967, the number of nurses and assistive personnel rose dramatically in part as a result of the influence of the:
a.	Children’s Bureau.	
b.	Hill-Burton Act.	
c.	Nurse Training Act.	
d.	Social Security Act.	

ANS:	C
The Nurse Training Act provided funding for nursing student education through scholarships, loans, recruitment, school construction and maintenance, and special educational projects. Until its passage, federal funding for nursing education was modest at best. The Children’s Bureau was created in 1912 in response to concerns about women and children’s health. The Hill-Burton Act provided federal funds for hospital construction and health care centers. The Social Security Act of 1935 included financial aid for older adults and Title V health care benefits for children with disabilities.

	11.	Mildred Montag’s major contribution to nursing is considered to be:
a.	encouraging minority women and men to enter nursing.	
b.	establishing associate degree nursing programs.	
c.	fighting for improved wages and recognition for nurses.	
d.	paving the way for the military to use trained nurses.	

ANS:	B
In response to the severe nursing shortage in the post–World War II years, Montag proposed a 2-year nursing associate degree that would prepare technical nurses in community colleges. Montag was not known for encouraging minorities and men to enter nursing. Montag’s major accomplishment was not fighting for improved wages and recognition. Montag was not involved in the military’s use of trained nurses.

	12.	Which nursing organizations are responsible for providing continuing education, establishing practice standards, and offering certification examinations for their members?
a.	Councils of nurse educators	
b.	National specialty organizations	
c.	State boards of nursing	
d.	State nurses associations	

ANS:	B
National specialty organizations, such as the American Association of Critical Care Nurses, arose in response to the developing nursing specialties; these organizations offer continuing education, practice standards, and certification exams for their members. Organizations that consist of nurse educators would be primarily concerned with nursing education. State boards of nursing are charged with the legal oversight of nursing in their respective states. State nurses associations are often lobbying and marketing organizations for nursing within a specific state and act as the state arms of the American Nurses Association.

	13.	What influence did Loretta Ford and Henry Silver have on the nursing profession?
a.	Advocated for laws allowing autonomous practice	
b.	Created a major scholarship for nursing education	
c.	Designed the first doctoral nursing program	
d.	Opened the first nurse practitioner program	

ANS:	D
Loretta Ford and Henry Silver opened the first nurse practitioner program (in pediatrics) at the University of Colorado in 1965. They did not advocate for laws allowing autonomous practice, create a major scholarship, or design the first nursing doctoral program.

	14.	What change is anticipated that will guide advanced practice nursing roles?
a.	Changes in federal funding for advanced education	
b.	Declining demand for advanced practice roles	
c.	Requirement of a doctor of nursing practice	
d.	Third-party payer restrictions on this type of practice	

ANS:	C
If the American Association of Colleges of Nursing Board (AACN) leadership holds sway, the doctor of nursing practice (DNP) will be the requisite preparation for all advanced practice nursing roles, including the NP, CNS, certified nurse midwife, and certified registered nurse anesthetist (CRNA), in the near future. It is not anticipated that there will be changes in federal funding for advanced education, a declining demand for advanced practice roles, or third-party payer restrictions on this type of practice in such a way that will guide advanced practice nursing roles as the requirement of a DNP will.

MULTIPLE RESPONSE

	1.	Benefits of the apprenticeship model of nursing education included: (Select all that apply.)
a.	a well-trained graduate nursing hospital staff.	
b.	opportunities for further education in nursing.	
c.	providing a skilled but inexpensive workforce.	
d.	providing working-class women employment.	
e.	reforms in the care of sick and injured individuals.	

ANS:	C, D, E
Nursing students provided the staffing for hospitals in exchange for their education. Nursing gave working-class women employment alternatives to domestic or factory work. The use of skilled, trained nurses decreased morbidity and mortality, and this benefit was evident in both civilian and military health care. Graduate nurses were typically employed as private duty nurses and did not remain working in hospitals. Further education for graduate nurses was rare; a postdiploma program was opened in 1899, but the first undergraduate college nursing program was not opened until 1909.

	2.	When nursing registration laws were enacted, a “registered nurse” was defined as someone who had: (Select all that apply.)
a.	attended an acceptable nursing program.	
b.	fit the definition of a professional nurse.	
c.	had not been convicted of any felonies.	
d.	passed a board evaluation examination.	
e.	studied under a standardized curriculum.	

ANS:	A, D
One of the two criteria for being a registered nurse was having attended an acceptable nursing program. The other criterion for being a registered nurse was having passed a board examination. A weakness of the early registration laws was a lack of definition of professional nursing practice. Background checks were not part of the early registry laws. Universal education standards were still lacking in 1903 when the first registry law was passed in North Carolina.

	3.	Nurses in private duty positions faced several hardships, including: (Select all that apply.)
a.	a shortage of nurses as schools limited enrollment.	
b.	a surplus of nurses starting in the mid-1920s.	
c.	employment that was sporadic and seasonal.	
d.	opportunities primarily working with poorer families.	
e.	pay that continued to be lower than other jobs.	

ANS:	B, C, E
The increased enrollment in schools led to a surplus of graduate nurses. Because communicable illnesses were often seen in the cooler months, employment for private duty nurses was seasonal. According to the Geister report (1926), nurses made less money than scrubwomen and worked in mostly short-term private duty cases. Schools were pressured to increase enrollment as the hospital census began to rise for the first time. Only the middle to upper class could afford to hire private duty nurses.

	4.	Community health nursing has been vital in shaping America’s health system and nursing in general by providing: (Select all that apply.)
a.	advocacy regarding matters of health and welfare.	
b.	autonomous nursing practice in patients’ homes.	
c.	means to check on patients’ compliance with treatment.	
d.	novel activities in health promotion and disease prevention.	
e.	treatment that didn’t rely on the patient’s ability to pay.	

ANS:	A, D
Community health nurses expanded nursing services to new areas, including school, industrial, tuberculosis, and infant welfare nursing. They combined their training and knowledge to educate the public and served as the backbone for the Maternal and Infant Act of 1921. Community health nurses combined their training and knowledge to bring education to the public to promote health and well-being. Private duty nurses had always been the mainstay of nursing work; these nurses worked semi-autonomously in patients’ homes. A system for determining compliance was not a part of the developing health care system in this country. The use of community health nursing increased because of concern with the public’s health, not the patient’s ability to pay.

	5.	Social events surrounding the Great Depression that had a major impact on American’s emerging health care system included: (Select all that apply.)
a.	Blue Cross was developed as a prepaid health insurance plan.	
b.	large hospitals experienced increasing numbers of nonpaying patients.	
c.	many hospitals found their nursing schools too expensive to operate.	
d.	nurses were hired in hospitals in increasing numbers.	
e.	religious orders began supplying trained nurses, cutting the cost of nursing.	

ANS:	A, B, C, D
The development of Blue Cross helped hospitals’ financial stability by providing patients who were able to pay for care. Large hospitals, particularly those in cities, experienced more patients who needed medical care but were unable to afford it because of the economic hardships of the Depression. A total of 570 training programs for nurses were closed because of prohibitive costs during the decade of the Depression. As hospital care became more sophisticated, more nurses were hired as staff. By 1941, more than 100,000 registered nurses were employed in hospitals. Religious orders did not provide trained nurses to hospitals to decrease the cost of the nursing staff.

	6.	The development of associate degree (AD) nursing programs has had which effect on nursing today? (Select all that apply.)
a.	A wider student pool has been able to study nursing.	
b.	AD programs have helped ease the nursing shortage.	
c.	Hospitals have been influenced to close their training programs.	
d.	Social status for graduates of nursing programs has improved.	
e.	The public has suffered some confusion about nursing education.	

ANS:	A, B, C, E
Nontraditional students, such as mothers and older students, have found it convenient to study nursing at community colleges. More nurses enter the profession via AD programs than through baccalaureate and diploma programs combined. As college education for nurses became more widespread and accepted, hospital directors became convinced to close their expensive programs, lessening the burden of hiring a professional nursing staff. The public and nursing suffer from confusion about the educational requirements for becoming a registered nurse. AD programs do not necessarily contribute to the improved social status of nurses.

	7.	Enrollment in college-based nursing programs was initially hindered by: (Select all that apply.)
a.	a lack of qualified applicants.	
b.	little social and financial support.	
c.	poorly trained faculty members.	
d.	restrictive admissions criteria.	

ANS:	A, B
Nursing education differed from medical education, which had seen a rise in stature as a result of social support and financial endowments. Aspiring nurses found the time and monetary commitment to be too great compared with diploma programs. Poorly trained faculty members were not a factor in limited enrollment into college programs. Restrictive admissions criteria were not a factor in limited enrollment into college programs.

	8.	Men in nursing in the early to mid-20th-century faced which barriers to practice and education? (Select all that apply.)
a.	Denial of professional status in the military	
b.	Frequent use of trained nurses as orderlies	
c.	Limited areas of health care in which to practice	
d.	Physical inability to perform delicate tasks	
e.	Societal bias that nursing was women’s work	

ANS:	A, B, C, E
Men in nursing faced multiple barriers, including denial of professional status in the military, the frequent use of trained nurses as orderlies, limited employment opportunities (e.g., in psychiatric care), and a societal belief that nursing was strictly women’s work. Men are physically able to perform delicate tasks.