Massachusetts Report on Nursing - December 2020

4 • <strong>Massachusetts</strong> <strong>Report</strong> on Nursing November 2020
clio’s corner
ANA’s first position on nursing education
Mary Ellen Doona
<strong>Massachusetts</strong>’ nurses opened their December 1965
issue of the American Journal of Nursing and found a six
page article: American Nurses’ Association (ANA) First
Position on Education for Nursing. That position was:
Education for those who work in nursing should
take place in institutions of learning within the
general system of education [and specifically, the]
minimum preparation for beginning professional
nursing practice at the present time should be
baccalaureate degree education in nursing.
Some nurses were startled at ANA’s calling for
baccalaureate education for entry into nursing practice
because the National League for Nursing had been
responsible for the accreditation process since 1949.
ANA had a prior claim on nurses’ education. Objective
two in its Article of Incorporation stated that ANA aimed
“to elevate the standard of nursing education.” 1 In Part
One of this article, we will review some of the history of
the relationship of the ANA and the development of the
educational requirements for Registered Nurses.
Nurses established the ANA because hospitals and
Medicine had taken over the emerging profession. Sophia
F. Palmer, an 1878 graduate of the Boston Training School
(the forerunner of <strong>Massachusetts</strong> General Hospital School
of Nursing), provided advice to ANA’s Founding Mothers
as they sought ways to recover nursing. She told them
that the power of the nursing profession was dependent
upon its ability to maintain the cooperation of individual
nurses who had the ability to influence public opinion. 2
She advocated forming Alumni Associations first. Twelve
Alumni Associations were founded soon after and were
invited to send delegates to the proceedings in 1896.
ANA’s original name emphasizes their importance. ANA
was originally called the Associated Alumnae of the
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United States and Canada, a title it held until 1911 when
the organization was renamed the American Nurses
Association.
Nursing history was a required course in a student’s
curriculum. Accordingly, most <strong>Massachusetts</strong>’ nurses
would have known of, and perhaps would have taken
pride in Palmer’s stellar career in keeping nurses across
the country together. Her pointed editorials in the
American Journal of Nursing kept nurses informed and
cheered them on as they gained laws to protect nursing
education. The RN-Registered Nurse- after a nurse’s
name from that time to this, signifies that history.
By 1911 nurses were concerned that nursing was
under the control of the hospital and the medical
profession. Nursing had prospered and provided valuable
service, but the gains they had made were subordinated
to the needs of hospitals and medicine. By this time
medical education had been restructured into a postbaccalaureate
endeavor, and limited the number of its’
schools, and thereby the number of individuals admitted
to the medical profession. Nurses wanted for nursing the
restructuring that the Flexner <strong>Report</strong> had achieved for
medicine.
Philanthropists rejected nursing’s proposals possibly
because the applicants were women. (Men were the
power brokers in the early years of the twentieth
century.) Women spent seven decades to gain the right
to vote and decades more to be at the table where
decisions were made. Nursing’s not being a university
endeavor was probably as significant as its’ being a
woman’s profession. Gertrude Weld Peabody, a member
of Boston’s social elite, daughter of a Harvard professor
and relative of a Boston doctor had no compunction
about using her advantage for the benefit of public health
nursing. That advantage was her family’s summertime
connection with John D. Rockefeller, Jr. Following her
note, he overrode the Rockefeller Foundation’s rejection.
The Foundation then agreed that funding public health
nursing fit into its goals.
Nursing finally had its’ own Flexner-like report with a
study formally known as Nursing and Nursing Education
in the United States (1923) though commonly referred
to as the Goldmark <strong>Report</strong> in honor of its investigator.
Josephine Goldmark was the sister-in-law of Louis D.
Brandeis and had collected much of the data for his
Brandeis Brief in a 1908 Supreme Court case that decided
long hours were detrimental to the health of women. 3
The Goldmark study was governed by a committee of
nineteen members including; ten physicians (two of
whom were hospital superintendents) outnumbering the
six nurses of which Mary Beard of the Boston Instructive
Nursing students in class at McLean Hospital
District Nursing Association (VNA) and Helen Wood then
Acting Superintendent at MGH were members. The two
lay members were Julia Lathrop of the Children’s Bureau
and Mrs John Lowman. C. E. A. Winslow, a Professor of
Public Health at Yale, chaired the study of 23 schools and
2406 students.
Goldmark reported among other things that the
average hospital training school was not organized on
a solid enough basis to be compared favorably with the
standards required in other professions. There were
too many students and too few of them were being
adequately prepared. Often the health of the students
was sacrificed to hospital service demands. Once Harvard
declined implementing the study’s recommendations,
the Rockefeller Foundation turned to Yale University
and funded its School of Nursing to make the requisite
changes. In 1934 its dean, Annie Goodrich, prophesized
that in a decade, 1944, every school of nursing should
definitely be associated with a college or university or be
discontinued. 4 In Part two of this article, we will explore
whether the optimism of Dean Goodrich was justified.
1 Lynda Flanagan, (compiler). One Strong Voice: The Story of
the American Nurses Foundation. (Kansas City: American
Nurses Association, 1976),32.
2 Flanagan, One Strong Voice, 30.
3 Kalisch, Philip A. and Beatrice J. Kalisch. The Advance of
American Nursing, 2nd edition. (Boston: Little, Brown and
Company, 1986),313.
4 Mary M. Roberts American Nursing: History and
Interpretation, (New York: The Macmillan Company, 1959),
515-516.