work."/>FIGURE 3.3 Chicago VNA nurse in patient's home, c. 1890s.
Source: Chicago VNA Collection, Midwest Nursing History Research Center, University of Illinois at Chicago, College of Nursing.
One of the foremost nurse leaders and activists at this time was Lillian Wald, who is regarded as the founder of U.S. public health nursing. After her nurse's training in New York, and disenchanted with her first job in a children's home, Wald entered medical school. During her first semester, in 1893, she was told of a need for a teacher to conduct a home nursing course for immigrants on the lower East Side of the city. Wald volunteered and thus changed her life and the lives of countless others. She described making her way to a student's home “… through crowded ‘evil‐smelling’ streets, past open courtyard ‘closets’, up slimy settlement steps, and finally into the sickroom” (Buhler‐Wilkerson, 2001, p. 99). That same year, 1893, Wald and her friend Mary Brewster founded New York City's Visiting Nurse Service and Wald founded the Henry Street Settlement House, a site for poor and immigrant children and families to receive social services and health care.
In 1889, 4 years before the Henry Street Settlement House, a group of society women in Chicago founded the Chicago Visiting Nurse Association (VNA). The Chicago VNA aimed to provide nursing care to the poor, many of them immigrants, in their homes. Remember, in these days before antibiotics became available in the 1940s, most invalids required long periods of nursing to recover from an illness or surgery. The Chicago VNA nurses were assigned to all parts of the city and cared for patients suffering from multiple diseases including tuberculosis, smallpox, and polio, as well as giving maternity and chronic disease care. Jane Addams, the Nobel Prize winner and founder of Chicago's Hull House Settlement, was a charter member of the Chicago VNA. One of the VNA nurses was based in Hull House. In 1892 her supervisor wrote: “No one could conceive the dirt and ignorance that the Hull House nurse has to contend with. She has often had to care for a typhoid fever patient in a small room crowded with a dozen or more chattering and gesticulating Italian men and women, not one of whom could speak a word of English. Pigeons underfoot or flying on the bed” (VNA Annual Report, 1892, pp. 14–15, cited in Lusk et al. 2016). We can reflect on the difficulties these families endured, in a strange city with a very ill loved one, enduring the dangers, the dirt, and the overcrowding. And one can admire the intrepid and hardworking nurses visiting these homes.
In addition, the Chicago VNA was an early provider of school nursing, industrial nursing, and social services. In 1893/4, the city's last major smallpox epidemic occurred. Chicago had 3,726 smallpox cases and 1,210 deaths. The city's smallpox hospital was so crowded that tents had to be set up to accommodate the overflow of disease victims. Chicago VNA nurses staffed a temporary isolation hospital and cared for 265 patients. Twenty‐six VNA nurses volunteered to work in this hospital and 4 contracted smallpox. In 1903, the VNA also formally recognized the high incidence and dreadful toll of tuberculosis and established a Tuberculosis Committee that became the Chicago Tuberculosis Institute in 1906 (Burgess, 1990).
Reflect on this. Over a hundred years ago, nurses exposed themselves to dangerous diseases such as smallpox, were active in public health such as forming a tuberculosis committee or initiating school nursing, and were responsible for skilled hospital work. Thus, nurses such as Harriett Fulmer, an early superintendent of the Chicago VNA and the founder of the Illinois State Association of Graduate Nurses, realized that trained nurses needed to organize in order to protect the name of “nurse” and thus the new profession of nursing.
The Development of Professional Nursing Organizations
Early on, nurse leaders saw the need for nurses to unite. Isabel Adams Hampton, a superintendent of the Illinois Training School for Nurses, who then founded the Johns Hopkins Training School for Nurses, attended the World's Columbian Exposition in Chicago in 1893. During the Exposition, multiple talks were presented, including talks by nurses in a nursing section chaired by Hampton. Edith Draper, superintendent of the Illinois Training School for Nurses, stated: “I know that to every thinking woman among us, the needs for a national organization are becoming more and more strongly realized, until now our success for the future depends on our unity” (Draper, 1894, p. 569). Hampton and others proposed forming an association. The 18 women present at the Chicago Exposition meeting, superintendents of nurse training schools across the country, founded the American Society of Superintendents of Training Schools for Nurses, now known as the National League for Nursing (NLN).
But these nurse leaders knew of the need for regular working nurses, not just superintendents, to have an association of their own. In 1896, 3 years after the American Society of Superintendents of Training Schools for Nurses was formed, 12 representatives from the society met with 12 members of nurse training school alumnae associations in Brooklyn, New York. There they formed the Nurses Associated Alumnae of the United States and Canada, now the American Nurses Association ANA. Isabel Adams Hampton was elected the first President (Keeling, Hehman, & Kirchgessner, 2018).
African American women during these times did not have the opportunities open to Whites. Nurses' training was rarely open to Black women in White hospitals and, likewise, the fledgling professional nursing organizations were not open to Blacks in all parts of the U.S. Thus, the leadership of such women as Martha Franklin, who graduated as a nurse in 1897, is all the more impressive. In 1907, Franklin, an African American graduate of the nurse training school of the Women's Hospital of Philadelphia, personally wrote 1,500 letters to Black nurses throughout the United States asking about forming a society. In 1908, 52 Black nurses met in New York and founded the National Association of Colored Graduate Nurses. Franklin was the first president. At the close of the first meeting, Lillian Wald invited the women to the Henry Street Settlement House for lunch and to offer support and mentorship (Keeling et al., 2018).
Lillian Wald was among those nurses who established another significant nursing organization, the National Organization of Public Health Nurses. In 1911, a committee, formed of members of the American Society of Superintendents of Training Schools for Nurses and the Nurses Associated Alumnae of the United States and Canada, met to standardize the field of public health nursing. They wrote to over a thousand organizations that employed public health nurses and, at the 1912 meetings of the two organizations held in Chicago, the public health organization was formed (Kandel, 1920). Wald, considered to be the founder of public health nursing, became the first president (Keeling, et al., 2018). It is instructive to appreciate how important public health nursing was at this time. We might think that nurses mainly worked in hospitals prior to quite recently—but they didn't. Nurses have been actively involved with public health, working to promote health and support home care, for centuries. In terms of leadership, these pioneers who founded early nursing organizations deserve our respect for their imagination and sense of purpose. Today, nursing organizations present a rich source of support for all nurses. Many nurses join a general national organization, such as the ANA, as well as one that is specific to their nursing specialty.
The following Table 3.1 lists just a few of the scores of national nursing professional organizations, beginning with the oldest, the American Society of Superintendents of Training Schools for Nurses.
Table 3.1 Professional Nursing Organizations Compiled by B. Lusk
| Year founded | Organization |
|---|---|
| 1893 | American Society of Superintendents of Training Schools for Nurses—now the National League for Nursing |
| 1896 | Nurses' Associated Alumnae of the United States and Canada—now the American Nurses Association |
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