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CHAPTER 3 The Freelance Nurse: Private Duty from 1920 to World War II In the 1920s and 1930s, most nurses graduated from the bustling wards ofhospital training schools to work in private duty, caring for a single patient at home or in the hospital. Unlike salaried public-health or hospital nurses, private-duty nurses operated as freelancers: their patients hired them and paid them by the shift or by the day. Nurses found their cases through hospital or private registries, which acted as employment bureaus. Doctors, nursing superintendents, and patients applied to the registries, which matched these requests with their lists ofnurses on call. Informal and often highly personal, the hiring networks and job situation ofprivate duty nursing preserved much of the atmosphere of nineteenth-century domestic nursing. The powerful, central position of hospitals in medical care today has all but obscured this history. The word "nursing " evokes images ofwhite-clad women in antiseptic hospital settings, but until World War II, private duty was the core ofnursing work. Few graduate nurses were hired to work on hospital staffs, and jobs in hospital administration and public health were largely restricted to nurses with more education or with diplomas from elite nursing schools. In 1920, 70 to 80 percent of all nurses worked in private duty. Such work amounted almost to another common experience ofinitiation, for even nurses who ended up in hospital or public-healthjobs usually began their careers in private duty. Freelance nurses served a broad public. Memoirs and surveys indicate that private duty was not exclusively or even primarily the privilege of the wealthy. Before 1930, many accounts portray the 78 CHAPTER 3 freelance nurse in a variety ofworkplaces, from lavish homes to crowded tenements and broken-down rural shacks. While the poorest families would call a nurse only in extremis, private -duty nursing was a commonplace accompaniment to illness in middle- and upper-class households. Such patients routinely called private nurses to attend minor ailments, convalescence , and childbirth, as well as when more serious illness struck. Private duty, then, played a prominent role in nursing as an occupation and in the layperson's experience of health care.! The changing context and experience of private-duty nursing in the 1920s and 1930s illuminate nurses' transition to the hospital workplace and the gradual eclipse of freelance practice. The years just before and after World War I created an aura of promise around private-duty nursing, a sense of expanding horizons that accurately indicated the new legitimacy of the trained nurse and her work, but that proved illusory for the specific form of freelance practice. As the United States moved toward war with Germany, a national call for mobilization ofnurses brought a sense ofurgency and importance to the hospital schools, and the rapid production ofnew nurses continued unabated. In the influenza pandemic of1918-19, lay and medical authorities urged young women to enter nursing. After the armistice, growing medical and lay demands for private nursing services seemed to promise a solid peacetime market to absorb the still-growing numbers of trained nurses. When the enrollment of student nurses dropped after the war, memories of the epidemic and of wartime scarcities brought alarmed cries of a nursing shortage . But the transitional years between the wars brought new developments in medical care and hospital organization that undercut private-duty nursing, even as broader social and economic shifts began to narrow its clientele. Although the majority of nurses worked as freelancers until World War II, such nurses were increasingly relegated to the margins of the emerging system of specialized care centered in hospitals. During World War II, the hvspital asserted its dominance over THE FREELANCE NURSE 79 nursing practice in decisive terms: since the 1940s, hospitals have claimed more nurses than any other employer. For the graduate of the 1920s, nursing meant private duty; for her counterpart of the 1940s, it meant work on a hospital ward. The transition from private duty to hospital staff work poised nursing between the claims of an older craft organization and the newer imperatives ofrationalization. Even under the adverse conditions of the 1920s and 1930s, private-duty nurses struggled to maintain their prerogatives as freelance workers. Acutely aware of the growing constraints on private -duty nursing, they still resisted employment in hospitals. In defending the organization of private duty as it was, they ran up against leaders' efforts to place nurses in salaried hospital jobs. Once again, leaders astutely assessed nursing's position in a changing situation: by...


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