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bow from my hair, and I was ready to go to work… Then the third night it was thought best to take charge of the night work as well as the day, and I was chosen for the first night nurse. What a responsibility!” (Schryver, 1930, p. 23) Figure 3.1.

FIGURE 3.1 Isabella Lauver.

      Source: Illinois Training School Collection, Midwest Nursing History Research Center, University of Illinois at Chicago, College of Nursing.

The Illinois Training School for Nurses at that time was responsible for just two wards in the sprawling Cook County Hospital—the female surgical and the male medical, each averaging 50 patients (Schryver, 1930). Apparently, Isabella Lauver did well—she graduated in 1882 after just over 2 years of nurse training. Her first year was spent working on the wards, her second year was spent either in the wards or being sent out as a private duty nurse in the homes of “the rich or the poor” (Schryver, 1930, p. 21). The only actual lectures were given in the evenings by the medical staff after the students had completed a 12‐hr working day. This type of nursing education was typical of nurse training schools of this era Figure 3.2.

FIGURE 3.2 Student nurses listening to a lecture after work. This photograph is from Chicago's Provident Hospital—a hospital founded in 1891 by African Americans to train African American nurses and physicians because they were not admitted to “White” hospitals.

      Source: Chicago Medical Society (1922). History of medicine and surgery and physicians and surgeons in Chicago. Chicago: Biographical Publishing Corp.

      Let us dissect Nurse Lauver's work in terms of management and leadership. Her superintendent described her as a woman of “calmness and common sense sufficient to make up for lack of experience” (Schryver, 1930, p. 24). She had to be! Imagine this young woman as the only nurse for a ward of 50 sick and/or post‐operative patients. And then imagine her as a young woman in 1882, nearly 40 years before women even had the right to vote, leaving her home to start training as a nurse. She was stepping out into the unknown into this new opening for women who wanted something meaningful out of their lives other than being a housewife or a teacher—the only other respected occupations open to women. For the next 47 years, Isabella Lauver worked as a nurse in private duty and in institutions (Schryver, 1930).

      Case Study 3.1

      M. Helena McMillan, an 1894 graduate of the Illinois Training School, founded Chicago's Presbyterian Hospital School of Nursing in 1903. McMillan, who had a college degree from Montreal's McGill University, planned a curriculum that focused on education rather than service. The first class attracted women from across the U.S. for the three and a half‐year program, which included a six‐month period with no clinical duties. Students needed a high school diploma to enter and one or more years of college were preferred. The school was affiliated with Rush Medical College. In 1903, McMillan wrote: “a special feature of the school is that the pupils will not be overworked.” McMillan was active in professional organizations including being a founding member of the International Council of Nurses in 1899. In Illinois, she spearheaded the passage of the state's first Nurse Practice Act in 1907. Upon her retirement in 1938, the American Journal of Nursing editors wrote that she had been “Associated with practically every progressive movement in nursing” (Lusk, 2001, p. 575).

      Compare McMillan's plan for nursing education, as Director of Chicago's Presbyterian Hospital School of Nursing, to the experience of Isabella Lauver at the Illinois Training School for Nurses 30 years earlier.

      Early nurse leaders such as McMillan would have objected to physicians who wanted nurses to be submissive and obedient. McMillan wanted well‐educated nurses who were legally protected by the state's Nurse Practice Act. Can you give some reasons, from the perspective of patient safety, why nurses today should continue to follow McMillan's lead and resist policy makers or others who want nurses to be submissive and obedient?

      Discuss the founding of nursing through the lenses of gender, society, science and place.

      1 Use the history of professional nursing to inform and guide decision making in nursing practice.

      2 Interpret the founding of professional nursing through the lenses of gender, society, science, and place.

      3 Appreciate nursing's important contributions to society's health.

      4 Articulate future challenges for nursing based on a critical analysis of nursing's past.

      Visiting Nurses and the Birth of Public Health Nursing

Other young nursing graduates opened up the field of public health nursing during these early years of the nursing profession as Visiting Nurses. These Visiting Nurses went to the homes of the poor to provide free nursing care and coordinate support services. Wealthier patients hired nurses to stay with them. The 1890s were years of severe economic need in the U.S.; an economic depression as severe as that of the more infamous 1930s Great Depression occurred. In addition, U.S. cities became home to thousands of immigrants who were new to the American language and customs. Some nursing organizations, staffed by a small cadre of trained nurses in the late nineteenth century, responded to the people adversely affected by these conditions. It is worthwhile noting that these nurses often connected with their patients through the use of the newly invented telephone. Patients and doctors typically called the local pharmacy and left messages for the nurse. The nurse, in turn, visited the pharmacy at a set time each day to review the messages and then plan her work Figure 3.3.

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,

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