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97 C h a p t e r 4 ˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚˚ Building the Modern World 1940–1960 As New Jersey State Nurses’ Association (NJSNA) members met in February 1941, to discuss the impact of relief programs and the fate of subsidiary workers, President Franklin D. Roosevelt was developing a two-ocean navy to safeguard the United States from germany on the east and Japan on the west.1 Struggling to remain isolated from efforts considered harmful, both Roosevelt and the NJSNA leadership—worlds apart yet historically interconnected—guarded against perceived threats. Nine months later, despite a tendency toward isolation , Americans, New Jersey nurses among them, entered World War II. The December 8, 1941, New York Times headline blazed: “Japan Wars on U.S. and Britain; Makes Sudden Attack on Hawaii; Heavy Fighting at Sea Reported.” “Sudden and unexpected attacks on Pearl Harbor, Honolulu, and other United States possessions in the Pacific early yesterday by the Japanese air force and navy,” a stunned nation read, “plunged the United States and Japan into active war.”2 As the United States joined the war against Axis countries, Roosevelt declared December 7, 1941, as a day that would live in infamy. At mid-twentieth century, external forces would change New Jersey nursing in ways and with speed inconsistent with nineteenth-century Victorian traditions. Torn between Two Worlds New Jersey nursing leaders in the early 1940s struggled to secure the status of registered nurses through legislation while also providing enough nursing care to meet the health needs of citizens. These goals, seemingly congruent, collided through a confluence of factors that emerged during the 1940s. As medicine increasingly adhered to Flexner’s definition of a profession, health care moved from home to hospital, with hospital expansion, demands for 98 On Duty more student nurses, and an evolving concept of health as the absence of disease. This concept shift—from health as the preservation of wellness to the absence of disease—occurred as new technologies and pharmaceuticals were introduced. Health care increasingly became hospital based, with physicians, predominantly male, as gatekeepers for entry to the system. Emerging as the singular authority on health matters, the physician commanded the social hierarchy in the 1940s, demanding an array of ancillary services to support him in the hospital as he cared for his patients.3 From 1931 to 1943, New Jersey hospital nursing schools decreased from fortyeight to forty-four while the number of student nurses increased from 2,606 to 3,553—a 36 percent increase. Concurrently, the average daily hospital patient census increased 26 percent, from 6,326 to 7,976.4 As physician practice became specialized, nursing care required more hours per patient, becoming more technology driven and time intensive.5 Thus, patient care demands escalated and cries of a nursing shortage continued. Nursing care was becoming an admixture of domestic service, assistance in activities of daily living, and administration of therapeutics. As physicians focused on disease management, nurses were compelled to adopt this new orientation and to fulfill its implications. given that general duty hospital nurses managed linen service, dietary service, general supplies, laboratory specimen collections and delivery, and transport service as well as direct patient care, the notion of a dire nursing shortage was pervasive— oftentimes referred to as “the nursing problem.”6 This problem was one of both definition—what constituted nursing care?—and numbers of student nurses available. By the mid-1930s, hospitals had begun to employ graduate nurses for eight-hour tours of general duty nursing. And, even more gradually, nondirect patient care duties—linen room services and general supply services—were assigned to others.7 Nurses were now providing care in both the home and the hospital. Wealthy patients employed private duty nurses on a one-on-one basis in the home or hospital, with fees established by the NJSNA. Poorer patients were placed on hospital wards, large open units with four to forty patients, managed by students or by a small, but gradually increasing number of employed graduate nurses. The ward patients either paid fees, depending on their resources, to both hospitals and physicians, or they were deemed charity cases. While student nurses continued to provide most nursing care in a country grown accustomed to free nursing care and free nursing education, graduate nurses were increasingly being employed by hospitals for general duty. The employment of graduate nurses was driven by inadequate numbers of students, pressure from national reports recommending employment of stable general duty staff, and closure of schools unable to...

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