Page 6 • DNA Reporter August, September, October 2018 In Harm’s Way – Nursing in World War II Carlene J. Campbell, MSN, RN Mrs. Campbell is an Assistant Professor of Nursing at Wor-Wic Community College in Salisbury, MD. She received her Master of Science in Nursing degree from Salisbury University with a focus on Clinical Education, her BSN from Wilmington University, and her diploma in nursing from Beebe School of Nursing. Her 38 years of professional Carlene J. Campbell experience includes Nursing Informatics, Perioperative Nursing, Intravenous Therapy and Medical-Surgical Nursing. Her interest in history, with a focus on nursing history, is a passion she shares with her husband Dr. William Campbell. She is a member of the American Nursing Informatics Association (ANIA), a member of Sigma Theta Tau International (STTI) and the Lambda Eta Chapter of STTI in Salisbury, Md. Carlene can be reached at email@example.com Nurses have cared for the sick and injured during war time in the United States beginning with the Revolutionary War. During the Spanish-American War this was carried out on a contractual basis with no uniformity in regulations or structure. It was recognized at the end of the Spanish-American War that an actual nursing department as part of the Army was needed and established in 1901 and the Navy in 1908. The number of nurses fluctuated with highs of twenty thousand during World War I to a low of 942 in June, 1940 at the beginning of World War II (WW II) (Tomblin, 1996). Initially, nurses were recruited for service through the American Red Cross registry. Along with the need for established nurses, it was recognized that more nurses would need to be trained to serve either at home to replace nurses going into the military or to join either the Army or Navy Nurse Corps themselves. This was accomplished by federal legislation in 1943 to establish the Cadet Nurse Corps which provided a full scholarship for nursing education to students who met the requirements in exchange for service (either civilian or military) for the duration of the war. This was an innovative solution to the severe nursing shortage, but most nurses did not graduate until after the war was over. Tomblin (1996) stated another benefit of the Cadet Nurse Corps was the admittance of African- American nursing students. The Army Nurse Corps would not consider this until after much pressure was applied. The first African-American nurse was admitted in 1941, but was permitted to work only with African-American soldiers. Men were also excluded from the ranks of the Army Nurse Corps. Male Registered Nurses (RN) who joined the military were given non-medical jobs or served as orderlies with the rank of Private compared with female Registered Nurses who were all admitted as officers. It was not until 1955 that the first male RN was permitted to serve in the Army (AMED, 2009). Throughout the war nurses selflessly put themselves in harm’s way to care for others. As the first wave of Japanese planes attacked Pearl Harbor, convalescent patients at the Schofield Barracks Hospital were being wheeled onto the sun porch. They witnessed the planes diving and explosions begin. Nurses immediately began wheeling the patients back to their rooms and shielding patients with mattresses in the event of bullets or flying debris. On one trip to the sunroom, a nurse was saved by an ambulatory patient as a Japanese plane began shooting at the hospital and bullets missed the nurse by inches (Tomblin, 2006). With the United States declaration of war against Germany four days after Pearl Harbor, plans were begun for the European invasion. Shockingly 57 unarmed nurses were included in Operation TORCH and landed under enemy fire along with combat troops on the beaches of Algeria carrying a bedding roll, canteen belt, and gas mask (Monahan & Neidel, 2003). Lt. Ruth Haskell made the following statement after arriving on the beach: An extraordinarily helpless feeling prevails in any medical group at such a time. We are technically noncombatants and unarmed. But we knew that someone out there in the darkness whom we could not see was taking pot shots at us and we could not retaliate. (1944, p. 77) Nurses were not safe at sea, in the air, or on the ground. During the transport of American and British nurses via a British hospital ship (HMS Newfoundland) it was attacked by a German plane. Many American nurses were injured as they tried to escape the burning and flooding ship, but seven British nurses perished due to the impact of the bombs (Monahan & Neidel, 2003). Flight nurse training to transport soldiers was begun in 1942 (Fessler, 1996). In 1944, one nurse was killed during a transport when the plane crashed into a mountain in France. Another transport, enroute to pick up patients with 13 flight nurses on board, crashed behind enemy lines in Albania. They traveled 800 miles on foot through the Albanian mountains while hiding from the Nazis to arrive at the coast where they were rescued two months later (Lineberry, 2013). All mobile medical facilities were under constant threat of attack. Foxholes were dug under cots and helmets were always within reach. One of the most deadly attacks happened to the 95th Evacuation Hospital in 1944. A skirmish between an English and German plane caused the German to dump his bombs in an attempt to gain altitude. The bombs landed on several of the hospital tents including the Operating Room. Three nurses were killed and four nurses received shrapnel wounds (Monahan & Neidel, 2003). In the Pacific Theatre nurses faced unimaginable hardships as well. Nurses stationed at Stotsenberg Hospital in the Philippines were evacuated when the Japanese invaded. They were first sent to Manila and within two weeks were moved to Bataan. The nurses and patients set up hospitals in Limay. One of which, General Hospital #2, was under the jungle canopy – completely open air with 17 wards and over 2,000 patients (Norman, 2013). Bataan fell in April, 1942 and the nurses were hurriedly evacuated to Corregidor at the Malinta Tunnel with its 1,000 bed hospital underground. Nurses here initially felt some comfort as they were no longer in the elements. While not plagued by insects, snakes, rats and monkeys, they had no food (Norman, 2013). Early in May, Corregidor was invaded by the Japanese and the nurses and doctors were then working under enemy control. They continued caring for patients even while Japanese soldiers pilfered valuables and attempted to sexually assault at least one nurse (Norman, 2013). Approximately seven months after the initial evacuation from the Philippines, all remaining medical personnel were taken to Manila and interred at Santo Thomas Internment Camp where they endured starvation and mental cruelty while continuing to work in the camp and care for those who were ill. Thirty three months later they were rescued and finally went home. Tens of thousands of nurses volunteered to serve and care for sick and wounded soldiers during World War II in both the European and Pacific Theatres with more than 200 killed while doing so (Army Nurse Corp, 2006). They came home when their duty was done and picked up their lives, most marrying and raising families. Few knew of the story of their courage and resilience in the face of danger or of the ones who gave the ultimate sacrifice, but all were in harm’s way. For more information the following website lists more than 100 books on WW II nurses: https:// ww2nurses.wordpress.com/world-war-ii-nurse-books/ References Army Nurse Corps. (2006). WW2 US Medical Research Centre. Retrieved from https://www.med-dept.com/ articles/the-army-nurse-corps/ Evolution of male Army Nurse Corps officers. (2009). U.S. Army Medical Department Office of Medical History. Retrieved from http://history.amedd.army.mil/ ancwebsite/articles/malenurses.html Fessler, D. B. (1996). No time for fear. East Lansing, Michigan: Michigan State University Press. Haskell, R.G. (1944). Helmets and lipstick: An army nurse in World War Two. New York: G.P. Putnam’s Sons. Lineberry, C. (2013). The secret rescue: An untold story of American nurses and medics behind Nazi lines. New York: Little, Brown and Company. Monahan, E.M. & Neidel-Greenlee, R. (2004). And if I perish: Frontline U.S. Army Nurses in World War II. New York: Anchor Books. Norman, E.M. (2013). We band of angels: The untold story of the American women trapped on Bataan. New York: Random House Publishing. Tomblin, B. B. (1996). G.I. nightingales: The Army Nurse Corps in World War II. Lexington, Kentucky: The University Press of Kentucky.
August, September, October 2018 DNA Reporter • Page 7 Diploma Nursing: Triumphs and Trials Nicole Hall, EdD, MBA, RN, CNE and Karen Pickard, MSN, RN, CNE Dr. Hall earned her nursing degree from Salisbury University and soon after began practicing in Delaware at Beebe Healthcare on their maternity unit. After eight years providing bedside care she took a nurse instructor position at Beebe’s, Margaret H. Rollins School of Nursing where she taught in the classroom and clinical Nicole Hall setting. During her time at Beebe she earned her MSN and MBA from Wilmington University. Most recently she completed her Doctorate of Education at Drexel University and is currently teaching undergraduate nursing at Salisbury University where she is an Assistant Professor. Feel free to contact Nicole by email at njhall@ salisbury.edu Karen L. Pickard earned her diploma in nursing from Beebe School of Nursing. She earned her Bachelors degree from Gettysburg College, and later earned her MSN from Wesley College. She is a Certified Nurse Educator through the NLN. In 2016, Karen completed a post-master’s certificate in Healthcare Administration at the Karen Pickard University of Delaware. She is currently enrolled in American Sentinel University’s DNP program, in the Executive Leadership track. She has worked for Beebe Healthcare for 18 years, starting in the Progressive Care Unit, then in Critical Care, and in 2004 she transitioned to the role of Nurse Educator for Beebe School of Nursing. Karen is currently the Program Administrator for the Margaret H. Rollins School of Nursing (Beebe) and has been in that position for four years. She is also a peer evaluator for the ACEN (Accreditation Commission for Education in Nursing). Karen can be reached by email at kpickard@ beebehealthcare.org or at her office at (302) 645- 3251 ext. 5593. 1800, this is not a reference to a year or to the military time. Instead, 1800 refers to the number of diploma nursing schools that existed in 1930, a time when nursing education through hospital-based programs peaked in our country (Doheny, Cook, & Stopper, 1997). The presence of diploma schools rose and fell in the 1900s, moving from training all nurses to educating just under 8% by the 1990s (Doheny, Cook, & Stopper, 1997). To understand the eruption of diploma prepared nurses and the subsequent decline in their numbers we will follow the evolution of the diploma program. In the 18th century the eastern United States still had connections to England and so the beginnings of training programs for nurses here followed the establishment of the Nightingale Training School in London (Judd & Sitzman, 2014). These early training programs were based in hospitals where “nursing students cheaply provided the bulk of the workforce needed to run a hospital” (Judd & Sitzman, 2014, p. 89), and so savvy administrators quickly saw the benefit of lengthening the training for nurses from one year up to three years. The academic year was extended beyond colleges and universities at the time which conducted classes 30 or so weeks per year, while nursing schools often lasted a demanding 50 weeks out of the year (Kalisch & Kalisch, 2004). Some early nursing students were required to work seven days and up to 90 hours each week for the duration of their training and when needed filled the roles of housekeepers and orderlies (Judd & Sitzman, 2014). These rigorous diploma programs were the earliest method of nursing education in the United States (Doheny, Cook, & Stopper, 1997), and US hospitals opened impressive numbers of them in the late 1800s and early 1900s (Kalisch & Kalisch, 2004). With nursing, women all over the world now had a “new and respectable career option” (Judd & Sitzman, 2014, p. 71). The numbers of diploma schools at hospitals increased exponentially moving from single digits in the 1870s to more than 400 schools in just 20 years as these students staffed and were trained “primarily for service in the hospital” (Kalisch & Kalisch, 2004, p. 416). In the mid 1900s, the approach to nursing education began to change from a focus on doing to knowing and from training to education (Judd & Sitzman, 2014). The philosophy of training nurses moved toward the expectation of “thinking with one’s head and not just working with one’s hands” (D’Antonio, 2010, p. 24). Beliefs evolved and nursing programs were thought of as better if they “focused education on both clinical and theoretical knowledge and not on the idea that service in the hospital would allow them to learn how to be nurses” (Judd & Sitzman, 2014, p. 159). With this outlook, nursing programs began to move from the hospital setting into the academic setting where education was provided by universities and colleges (Judd & Sitzman, 2014). The preparation of nurses began to vary, no longer consisting solely of diploma programs as education “became increasingly integrated into the academic setting during the late 60s and early 70s” (Kalisch & Kalisch, 2004, p. 416). This integration coincided with and was surely influenced by the American Nurses Association (ANA) 1966 resolution: The education for all those who are licensed to practice nursing should take place in institutions for higher education; minimum preparation for beginning professional nursing practice should be a baccalaureate degree; minimum preparation for beginning technical nursing practice should be an associate degree in nursing. (Judd & Sitzman, 2014, p. 233) The ANA made no mention of diploma programs and where they fit into the plan to educate nurses. Yet the ultimate demise of so many diploma programs was triggered by the realization that running these schools was costly. The main means of preparing nurses no longer meant long hours working in the hospital, now nurses were spending increasing time learning in classrooms. The 1970s saw a massive decline in the numbers of diploma programs, with “30-40 programs closing each year” (Kalisch & Kalisch, 2004, p. 416). And so it went, that when training nurses was a financially beneficial endeavor for hospitals, diploma programs thrived; when these programs became costly, the doors for many of these programs were closed forever. Today about 67 diploma based nursing schools continue to educate students, a far cry from the 1800 that once trained entry level nurses (NLN, 2014). In Delaware, the vast majority of nurses graduate from community colleges or universities yet diploma education has an extensive history in this state which continues as Beebe Medical Center graduates nurses from its hospital-based nursing diploma program each year. The Margaret H. Rollins School of Nursing, located in Lewes, has a long-standing tradition of producing graduate nurses who excel on the National NCLEX exam as well as in the nursing workforce. Embarking on 97 years of education, the school is highly supported by the community it serves, as well as the Beebe Board of Directors. Beebe School of Nursing began as a nurses training program in 1921, founded by Dr. James Beebe Sr., and his younger brother Dr. Richard Beebe (George, 2017). Beebe was the first school in Delaware to seek accreditation which prompted the Board of Examiners to draft legislation giving specific power to the Board for accrediting schools (George, 2017). This later became a vital component of the Nurse Practice Act and one of the primary functions of the Board of Nursing. The beginning years of nursing education in diploma programs was considered “learning on the job.” Classes were taught when time allowed, otherwise nursing students worked in the hospital providing patient care. The curriculum at the Margaret H. Rollins School of Nursing has evolved over the years to keep in stride with best practices in nursing education. Beebe School of Nursing was granted a very generous donation in 2011 by Mr. and Mrs. Randall Rollins. This donation precipitated the building of a new state-of-the art educational facility as well as the renaming of the school in honor of the Rollins family (Beebe Healthcare.org, 2018). The new facility offers high fidelity simulation labs, innovative classrooms, and modern student spaces. While nursing education has certainly evolved, Beebe Medical Center is proud of the accomplished nurses that continue to graduate from the Margaret H. Rollins School of Nursing. The school maintains some of the highest NCLEX pass rates in the state, continues to have 100% job placement for graduates, and maintains articulation agreements for higher education with the University of Delaware, Wilmington University, and Wesley College (Division of Professional Regulation, 2018). These educational partnerships allow graduates to attain their RN license and then complete their BSN all in Sussex County, providing Delawareans with local access to an affordable nursing education. In 2021, the Margaret H. Rollins School of Nursing will celebrate 100 years of quality nursing education and tradition. While diploma programs are certainly outnumbered nationwide by Associate and Baccalaureate programs, the tradition of experiential learning in diploma education lives on in Delaware. References Beebe Healthcare.org. (2018). The Margaret H. Rollins Story. Retrieved from https://www.beebehealthcare.org/ school-nursing-about-us/margaret-h-rollins-story D’Antonio, P. (2010). American nursing: A history of knowledge, authority, and the meaning of work. Baltimore: Johns Hopkins University Press. Division of Professional Regulation. (2018). Delaware Board of Nursing NCLEX Statistics. Retrieved from https://dpr. delaware.gov/boards/nursing/passrates/ Doheny, M. O., Cook, C., & Stopper, M.C. (1997). The discipline of nursing: An introduction (4th ed.). Upper Saddle River, NJ: Prentice Hall. George, P. (2017). Two men with a dream: The story of Beebe Healthcare (1st ed.). Portfolio Publication - Books. Judd, D., & Sitzman, K. (2014). A history of American nursing: Trends and eras (2nd ed.). Burlington, MA: Jones & Bartlett Kalisch, P., & Kalisch, B. (2004). American nursing: A history (4th ed.). Philadelphia: Lippincott Williams & Wilkins. NLN. (2014). Number of basic RN programs, total and by program type: 2005 to 2014. 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