The National League for Nursing

The National League for Nursing developed the first Standards for Nursing Education in 1917. At that time nursing education programs ranged in length from 6 months to 2 years, and nearly all nurse training programs were associated with hospitals (Egenes, 2009). It wasn’t until 1938 that the National League for Nursing Education developed a credentialling arm to evaluate and certify nurse training programs.

Josephine C. Goldmark and the Goldmark Report

In 1919 as secretary for the Rockefeller Foundation Committee for the Study of Nursing Education, Josephine Goldmark (1877-1950) assumed the role of principal investigator and visited and studied over 70 schools of nursing over the next four years. She observed, among other concerns, that most of the hospitals were staffed with student nurses and that patient care took precedence over the education of the students. Her written report was published in 1923 as Nursing and Nursing Education in the United States but was most often referred to as The Goldmark Report. Her 1923 Report prompted the upgrading of nursing education through recommendations that hospital schools be affiliated with universities and that national accreditation be required. (https://www.britannica.com/biography/Josephine-Clara-Goldmark)

Frances Payne Bolton and the Bolton Act

As an advocate for nursing after World War I, Frances Payne Bolton (1885-1977) persuaded Secretary of War Newton D. Baker to establish an Army School of Nursing instead of relying on untrained volunteers. In 1923, she contributed funds to “establish and endow the School of Nursing at Case Western Reserve University.” When her husband died in 1939, Bolton served out the rest of his Congressional term. She then ran for office in 1940 and became the first elected congresswoman from Ohio and an esteemed leader serving for a total of fifteen terms in the U.S. House of Representatives. (https://case.edu/nursing/about/history/about/history-frances-payne-bolton)

World War II brought renewed awareness of the importance of nurses to the care of soldiers. Frances Payne Bolton introduced a bill in 1942 giving nurses in the military equal pay with male officers and regular officer status. Before that time nurses had the same rank but received less pay and fewer privileges. In 1943, she introduced the Bolton Act which established the Cadet Nurse Corps. It was the largest federally funded program that tied education of nurses with the federal government. Over the next five years the U.S. Cadet Nurse Corps graduated 124,065 nurses. At that point 85 per cent of all nurses were Cadet Nurses. Bolton would continue on in her distinguished congressional career to sponsor several other bills that supported equal access to nursing education.

Lucile Petry Leone and the Cadet Nurse Corps

Lucile Petry Leone (1909-1999) was one of only a few nurses with a doctoral degree in the 1930s. She received her bachelor’s from the University of Delaware with majors in chemistry and English. At an undergraduate summer job working as a nurse’s assistant, she had decided she wanted to “see science work.” As a nurse she would be engaged “with people not things” as well as working “with both my hands and my head,” so she enrolled at Johns Hopkins School of Nursing. After obtaining her nursing degree, she topped off her education with a master’s and several years later a doctorate from Columbia Teachers College. (https://en.wikipedia.org/wiki/Lucile_Petry_Leone)

She was recruited by the University of Minnesota, where she eventually became assistant dean of the College of Nursing. Initially “on loan” from the University at the outset of World War II to serve as a consultant to the U.S. Public Health Service with “the directive to accelerate nursing education nationally,” she stayed on and in 1943 she became founding director of the Cadet Nurse Corps. Women interested in joining the Corps would enroll at Schools of Nursing across the country where they participated in 24- to 30-month accelerated nurse training programs. The government would pay for tuition, fees, room and board, uniforms, and a monthly stipend. The women had to pledge to “engage in essential nursing, military or civilian, for the duration of the war.” Leone remained with Public Health after the war and in 1949 became “the first woman and the first nurse to be promoted to assistant surgeon general of the U.S. Public Health Service” (Glass 2009, 75-77, 107-08).

Esther Lucile Brown and the Brown Report

Esther Lucile Brown (1898-1990) was a Yale-educated social anthropologist working for the Russell Sage Foundation during the 1930s. She was tasked with studying various medical professions in an ongoing effort to improve the social and physical environment of hospitals and raise the level of staff competence. Following World War II, the Foundation asked Brown to focus specifically on nursing. In 1948, her work was published as Nursing for the Future, often referred to as The Brown Report. The Brown Report recommended that nursing education be moved to college-based educational programs. At the time of her analysis almost all nursing programs were hospital-based, and the work of the hospital took precedence over the educational development of students. Besides urging nurse education be college-based, Brown also advised that nursing programs be accredited and that students be carefully selected for admission to these nursing programs. (https://en.wikipedia.org/wiki/Esther_Lucile_Brown)

In the 1950s Brown turned her attention to mental hospitals. With coauthors Greenblatt and York, Brown researched and published From Custodial to Therapeutic Care in Mental Hospitals (1955). This book reported on the success of experimental changes, including “elimination of restraints, encouragement of improved patient behavior and appearance, increased recreation and occupational facilities, enlarged patient responsibility for ward housekeeping and fellow patients, close relationship among staff categories and between staff and patients, closer cooperation with family and community, development of patient self-government, psychodrama, and staff consultations with patient participation,” on the rehabilitation of patients (Greenblatt, York, and Brown 1955, “Abstract.” https://psycnet.apa.org/record/1956-06067-000). It would influence the movement to relocate treatment of mental health disorders from state mental hospitals to community-based care (Yohanna 2013, 886-91).