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Constituent member of ANA
The mission of the Delaware Nurses Association is to improve healthcare in Delaware by the advancement of nursing.Quarterly publication direct mailed to approximately 12,000 RNs and LPNs in Delaware.
Volume 43 • Issue 3 August, September, October 2018
Reporter The Official Publication of the Delaware Nurses Association
In Harm’s Way – Nursing in World War II
Diploma Nursing: Triumphs and Trials
Carlene J. Campbell, MSN, RNNicole Hall, EdD, MBA, RN, CNE
Karen Pickard, MSN, RN, CNE
current resident or
Presort StandardUS Postage
PAIDPermit #14
Princeton, MN55371
Nurse Peer Support Group . . . . . . . . . . . . . . 2
President’s Message . . . . . . . . . . . . . . . . . . . 3
Nursing History: Where We Came From . . . . 4
In Harm’s Way – Nursing in World War II . . . 6
Diploma Nursing: Triumphs and Trials . . . . 7
A Case for Going with “Flo”: Why Modern Nursing and Nursing Education Should Embrace Florence Nightingale . . . . . . . . . . 8
The Hospital Steward: His Relationship to Nursing . . . . . . . . . . . . 9
DelawareToday TopNurse 2018 . . . . . . . . . . 10
InsideDNA
REPORTER
Executive Director’s ColumnGuest Editor
William T. Campbell, EdD, RN
Dr . Campbell is a firm believer in the importance of history . While not a fan of history in school, he has learned to appreciate it over time and today it accounts for a major portion of his professional endeavors and personal past times . Over 100 presentations, posters, and journal articles on various topics of nursing and medical history, especially during the Civil War era, have been authored by him . He is a member of the American Association for the History of Nursing (AAHN) and a member, volunteer, and docent at the National Museum of Civil War Medicine in Frederick MD .
Dr . Campbell is a Professor of Nursing at Salisbury University (SU) in Salisbury MD . He teaches undergraduate courses in Pediatrics and Pharmacology . He is also faculty in the Honors College at SU where he teaches the course he is most proud of, The History of Nursing, a course that he originally developed .
Prior to his arrival at SU 20 years ago, he taught at Delaware Technical & Community College in Georgetown . His nursing career began at Milford and Nanticoke Memorial Hospitals . All located in Sussex County where he continues to reside today with his wife, Carlene .
Dr . Campbell earned his Doctor of Education at the University of Delaware, his Master of Science as a Clinical Nurse Specialist in Family Nursing at Salisbury University, and his undergraduate degrees in Nursing, Psychology, and Biology at the University of Delaware . He is a member of DNA, ANA, and Sigma Theta Tau International where he served on an international taskforce to recognize military nurse heroes .
Dr . Campbell may be reached at wtcampbell@salisbury .edu
William T. Campbell
In this issue of the DNA Reporter we will spend some time on the history of nursing! “If you have no history, you have no future .” ~ A . Toynbee History is important to each of us and equally so to a profession . If we as
individuals, or as a profession, do not learn from our mistakes, we are doomed
Guest Editor continued on page 2Executive Director’s Column continued on page 3
Sarah Carmody
Sarah J. Carmody, MBA
The Delaware Nurses Association and Delaware Today Magazine celebrated Top Nurses in our state at a wonderful gala held in May . Each year that I attend this event, I have the pleasure of seeing old friends, meeting new ones, and seeing the families that support and care for these nurses . Nursing can be hard, dealing with difficult patients with compassion and understanding, balancing work and life, and the aches and pains that seem to creep into joints and backs over the years of caring for patients at the bedside .
As I was thinking about this, it gave my mind a chance to wonder more about the profession that I have worked for over the last fourteen years . I started randomly searching varied adjectives that are used to describe nurses when I came across Sister Simone Roach’s 5 C’s of caring from the University of St . Mary . The 5 C’s are commitment, conscience, competence, compassion, and confidence .
Commitment is described as going above and beyond what is expected and constantly striving to improve oneself through education and training which can lead to improved patient care and outcomes .
Conscience is the ethical and moral principles that help guides the nurse’s actions to do the right thing though other pressures may want to distract from caring for the patient to the best of their abilities .
Competence is holding oneself to a high level of excellence . Not because the nurse is obligated but because it is an intrinsic desire to provide the best nursing care possible . This leads back to commitment and the maintenance of knowledge and skills .
Compassion is what gives patients a positive experience by knowing the nurse can empathize with them while providing kind and competent care . In return, this nurtures the value the nurse finds in their work and has greater affect on patient care .
Confidence brings all parts together–a high level of excellence achieved through knowledge, guided by high ethics and moral principles while providing compassionate care to patients when they are going through the joys and sadness of life .
Page 7Page 6
Page 2 • DNA Reporter August, September, October 2018
to repeat them . There are many lessons to be learned today to improve the future and likewise lessons of the past to improve today .
The first “article” will discuss how nursing has changed over time . It is edited and rewritten from the Keynote Address at the Delaware Nurses Association’s (DNA) 2011 Spring Conference, April 7, 2011, in Newark, DE on occasion of DNA’s 100th anniversary . Following that general reflection on nursing history, this issue will present four new articles on various related topics of nursing history .
Guest Editor continued from page 1
OFFICIAL PUBLICATIONof the
Delaware Nurses Association
4765 Ogletown-Stanton Road, Suite L10Newark, DE 19713
Phone: 302-733-5880Web: http://www.denurses.org
The DNA Reporter, (ISSN-0418-5412) is published quarterly every February, May, August and November by the Arthur L. Davis Publishing Agency, Inc., for the Delaware Nurses Association, a constituent member association of the American Nurses Association.
EXECUTIVE COMMITTEE
President President-ElectLeslie Verucci, RN, MSN, Gary W. Alderson,CNS, CRNP-A, APRN-BC RN, Esq.
Treasurer SecretaryJon M. Leeking, Christopher E. Otto, MSN, RN BSN, RN, CHFN, PCCN, CCRN
COMMITTEE CHAIRS
Continuing Education CommitteeKathleen Neal, PhD, RN on Nomination Felisha A. Alderson, Professional Development MSN, RN, CRRN
May Oboryshko, DNP, RN Terry Towne, MSN, RN-BC, NE-BC
LegislativeMembers of the Board of Directors
CommunicationsWilliam T. Campbell, Ed.D, RN
Karen Panunto, Ed.D, MSN, RN, APRN
Executive DirectorSarah J. Carmody, MBA
Subscription to the DNA Reporter may be purchased for $20 per year, $30 per year for foreign addresses.
For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. DNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the Delaware Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. DNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of DNA or those of the national or local associations.
Managing EditorsWilliam T. Campbell, Ed.D, RN
Karen Panunto, Ed.D, MSN, RN, APRN
The DNA Reporter welcomes unsolicited manuscripts by DNA members. Articles are submitted for the exclusive use of The DNA Reporter. All submitted articles must be original, not having been published before, and not under consideration for publication elsewhere. Submissions will be acknowledged by e-mail or a self-addressed stamped envelope provided by the author. All articles require a cover letter requesting consideration for publication. Articles can be submitted electronically by e-mail to Sarah J. Carmody, MBA @ [email protected].
Each article should be prefaced with the title, author(s) names, educational degrees, certification or other licenses, current position, and how the position or personal experiences relate to the topic of the article. Include affiliations. Manuscripts should not exceed five (5) typewritten pages and include APA format. Also include the author’s mailing address, telephone number where messages may be left, and fax number. Authors are responsible for obtaining permission to use any copyrighted material; in the case of an institution, permission must be obtained from the administrator in writing before publication. All articles will be peer-reviewed and edited as necessary for content, style, clarity, grammar and spelling. While student submissions are greatly sought and appreciated, no articles will be accepted for the sole purpose of fulfilling any course requirements. It is the policy of DNA Reporter not to provide monetary compensation for articles.
ReporterCarlene Campbell, MSN, RN, will share stories
of the brave nurses of WWII who risked their lives for their patients . Nicole Hall, EdD, MBA, RN, CNE, and Karen Pickard, MSN, RN, CNE, will enlighten us about the three year diploma nursing schools that were so popular once, but so rare today . Lynn Derickson, EdD, MS, RN, CNE, will discuss Florence Nightingale and her impact on nursing today . And then an article by me, William T . Campbell, EdD, RN, on Hospital Stewards will present what may have been the first Advanced Practice Nurses over 150 years ago .
Did you know the DNA Reporter goes to all registered nurses in
Delaware for free?
Arthur L. Davis Publishing does a great job of contacting advertisers, who support the publication of our newsletter. Without Arthur L. Davis Publishing and advertising support, DNA would not be able to provide the newsletter to all the nurses in Delaware.
Now that you know that, did you know receiving the DNA Reporter does not automatically provide membership to
the Delaware Nurses Association?
DNA needs you! The Delaware Nurses Association works for the nursing profession as a whole in Delaware. Without the financial and volunteer support of our members, our work would not be possible. Even if you cannot give your time, your membership dollars work for you and your profession both at the state and national levels. The DNA works hard to bring the voice of nursing to Legislative Hall, advocate for the profession on regulatory committees, protect the nurse practice act, and provide educational programs that support your required continuing nursing education.
At the national level, the American Nurses Association lobbies, advocates and educates about the nursing profession to national legislators/regulators, supports continuing education and provides a unified nationwide network for the voice of nurses.
Now is the time! Now is the time to join your state nurses
association! Visit www.denurses.org to join or
call (302) 733-5880.
Did ?YouKnow
The Delaware Nurse Peer Support Group strives to create a safe space for nurses to share their experience, strength and hope with other nurses in recovery, and supports the goal of abstinence from addictive substances and achievement of a meaningful recovery . This monthly meeting is open to all nurses that have experienced problems related to alcohol or substance use . A confidential atmosphere is key, therefore, the group members expect other participants to respect and maintain their anonymity .
If you are interested in attending, please feel free to join us . If you have any questions about the meeting, or are interested in co-facilitating a group, please email: gamblenp@comcast .net . Meeting times and locations will be listed on the DNA web site and changes such as cancelations will be posted on DNA’s Facebook page . Advanced registration is not required to attend .
Kent CountyMeets on the 1st Thursday each month from 7:30
– 8:30 PM St . John’s Lutheran Church, 113 Lotus Street, Dover, DE 19901 .
Malpractice Defense & Board Complaint DefensePersonal Injury, Wills, Guardianships,
General Litigation
Elzufon Austin & MondEll, P.A.300 Delaware Ave., Suite 1700 | Wilmington, DE 19801
302-504-3231 | [email protected]
GAry W. AldErsonAttornEy At lAW, rEGistErEd nursE
August, September, October 2018 DNA Reporter • Page 3
Working with the Delaware Nurses Association for so many years I have had the chance to meet some great nurses both new and experienced . The Delaware Nurses Association has made me feel important and a part of a great team . As a group so much is done to promote the role of the Registered Nurse (RN) and the Advanced Practice Registered Nurse (APRN) both at the state and national level . We would love to have more volunteers who are interested in moving the profession forward . DNA Needs You!
Join a committee! Make a positive contribution to the nursing profession by engaging in DNA activities . Make new friends! Committee participation provides an opportunity to network and make new connections . Learn something new! Want to learn how to develop continuing nursing education or how to engage in advocacy work? Let DNA show you how .
As part of our mission and goals, the Delaware Nurses Association advocates for nurses in Delaware by:
• Educating legislators about the profession of nursing and their role in the delivery of quality and affordable healthcare
• Protecting the Nurse Practice Act• Supporting the interest of healthcare
consumers and all Delaware nurses in the state and national arenas
Delaware Nurses Association will be there to help support the nursing workforce and work to educate our legislators and the public of the role and what we are there to do . I would also like to see our membership grow allowing us to create more events and programs within the state providing education and social events so that nurses will have the opportunity to network . We have a vast and wonderful array of knowledge within the State
President’s Message
Leslie Verucci
These qualities are what make nurses the most trusted profession and qualified to participate in and lead improvements in the delivery of healthcare . Additions to commitment can also include commitment to the profession of nursing by educating the public on the role of nursing and by advocating for the advancement of nursing and patient care in the policy arena .
The Delaware Nurses Association relies on volunteers to advocate for the profession at Legislative Hall . If this is of interest to you, please contact DNA at (302) 733-5880 or send an email to sarah@denurses .org .
The DNA Fall Conference is scheduled for October 12, 2018 at DelTech Community College-Terry Campus, Dover . I hope to see you there!
Additionally, the DNA Continuing Education Committee is offering a training on how to develop and evaluate continuing nursing education . These training events will be held throughout the summer, however, if you would like to schedule a training session at a different time, please contact the DNA office at (302) 733-5880 or send an email to sarah@denurses .org .
Congratulations to our Top Nurses and to all nurses, thank you for what you do in caring for patients and our communities . If you are not a DNA member, please join us!
Executive Director’s Column continued from page 1
Mission: To improve healthcare in Delaware by the
advancement of nursing .
Vision: To shape the future of healthcare and promotion
of innovative nursing practice .
Priority 1:Membership Growth and EngagementProfessional growth and advancements in
nursing happen best when nurses are supported by collegial networks of like-minded professionals . DNA will provide value to Delaware nurses and grow the association’s membership by connecting members through online communities and meetings, committee activities, membership directory, advocacy work, and offering free and discounted continuing education .
Priority 2: Professional DevelopmentContinuing education actively engages all
members of the DNA community in continuous professional growth, which is designed to increase competency and innovative nursing practice . Through an environment of collegiality and collaboration, DNA members will have opportunities to increase knowledge, improve performance, and enhance professional satisfaction .
Priority 3: AdvocacyTo meet the DNA mission of advancing nursing
to improve healthcare in Delaware requires the participation of all nurses in Delaware and input from their diverse areas of practice . The IOM Future of Nursing Report discusses the importance of transforming and advancing nursing practice to improve patient care . Our members should engage legislators with the message that all nurses should be allowed to practice to the fullest extent of their education and training and for workplace standards that foster safe patient care and support the profession . DNA will work to advance these foundational principles .
Priority 4: ProgramsNurses are the backbone of the healthcare
workforce and all nurses matter . DNA will support nurses through professional resources that help new nurses stay in the profession, retired nurses to maintain their license, and nurses to maintain sobriety while continuing to provide safe patient care .
Priority 5: Strategic PartnershipsDNA will partner with specialty nurse
organizations, student nurses associations, educational institutions, hospitals, and other stakeholders to support DNA advocacy work and the lifelong learning needs of licensed practical nurses, professional registered nurses and advanced practice registered nurses .
Priority 6: Association VitalityDNA will work to strengthen DNA’s operation,
programmatic infrastructure and economic stability to ensure continued success in advancing association priorities .
About DNA
of Delaware that we need to tap into and share with others . Groups like the DNA offer an environment for all RNs no matter the specialty to learn and grow .
Our legislative group is working and watching all new and revised legislation that may affect nursing, making sure that no language or changes create barriers or decrease our ability to provide care at our fullest level of education/knowledge . This group is also looking at legislation that will provide some safety nets for the RN/APRN’s in the state . By actively participating in the legislative process and fulfilling a professional obligation to participate in the policy making process, registered nurses can contribute to building a safe, quality, patient centered, accessible, and affordable healthcare system (Institute of Medicine, 2011) . Patients and the public benefit from the improved health care quality that results in the registered nurses’ involvement in health policy . If you are interested in learning more and working with our legislators to make Delaware a more healthy, safe, and barrier free state for our nurses to be employed in, please consider joining our group .
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Emergency & Trauma RNsBe a part of our Magnet ®- Recognized Team!
Leadership positions are also available.Bayhealth is the largest healthcare provider in central and southern Delaware. We are comprised of two acute care centers Kent and Milford Campus, the freestanding Emergency Department in Smyrna as well as numerous satellite facilities and employed physician practices encompassing a variety of specialties. We are a Magnet Designated Hospital, which recognizes healthcare organizations for quality in patient care, nursing excellence and innovations in professional nursing practice. Magnet is the leading source of successful nursing practices and strategies worldwide.
As a reputable community based health system, we are focused on the diverse needs of our patients delivering evidence-based award winning care. Bayhealth is a technologically advanced not-for-profit healthcare system with more than 3,700 employees and a medical staff of more than 400 physicians and is an affiliate of Penn Medicine for Heart and Vascular, Cancer and Orthopedics. Our committed staff of employees, physicians and volunteers work together to deliver our mission of improving the health status of all members of the Bayhealth community while demonstrating our values of compassion, accountability, respect, integrity and teamwork.
The Kent Emergency Department (located in Dover, DE) is a Level III Trauma Center, certified Primary stroke center with 39 bed ED with over 50,000 in annual ED visits. Our professional nurses provide high quality, safe care and are committed to professional growth! Teamwork is emphasized and the nursing culture is empowered through shared governance. Professional nursing practices requiring specialized critical thinking and skill are performed in accordance with hospital policy, procedures and nursing philosophy.
At Bayhealth, Nursing excellence is our standard.Please apply online: www.bayhealth.org/careers
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Page 4 • DNA Reporter August, September, October 2018
Nursing History: Where We Came Fromon April 18, 1911, but would not join the American Nurses Association (ANA) until 1916 . ANA had started in 1896, but was then called Nurses Associated Alumnae of the US and Canada . Canada was dropped in 1901 . In 1911 the name changed to ANA but its constituents were still associations, not states . In 1916, its constituents became the states, Delaware joined, and ANA closely aligned itself with the American Journal of Nursing and the National League of Nursing Education . So close in fact that they shared clerical staff .
What did nursing in Delaware look like in 1911? Nurses were being trained at hospitals for 3 years,
in hospital based schools, owned and operated by the hospital, taught theory content in lecture by the physicians, supervised in clinical on the units by the head nurses and supervisors . It was mostly an apprenticeship, on-the-job training for the student, and free labor for the hospital . A donation of the lecture notes of a nursing student from the 1920’s for the Nursing Departmental Museum at Salisbury University was recently reviewed . The notes for each lecture had the name of the male physician lecturer at the top, the pages of notes were corrected by him, and then initialed by him at the bottom of the last page . Lectures were in anatomy, physiology, bacteriology, chemistry, psychology, and hygiene . At that time there were 74,000 nurses in the U .S .
How many nurses were there in Delaware in 1911?
The Board of Nursing doesn’t have records to tell us how many, but they do know that in 1911, that year 18 new nurses received their licenses . The Delaware Board of Examiners for Nurses had started in 1909 charged with “regulating the practice of professional nursing in the State of Delaware .” There were no LPN’s, RN’s, or APN’s, just “professional nurses .” There was no exam for licensure, those 18 were granted licensure by “waiver” – “waiver” remains undefined and unrecorded . The licensing exam started the following year in 1912 – 5 days of paper and pencil testing with no computers and no 265 question maximum . It was administered only twice a year! Today there are over 18,000 nurses in Delaware .
Where were nurses trained in Delaware?These nurses learned their profession at hospital-
based training schools such as The Delaware Hospital School of Nursing . That school started in 1901 and in 1911 graduated 6 students – the largest class in 11 years! Some years there were only 3-4 students . Delaware Hospital started in 1890, became Delaware Division of the Wilmington Medical Center, then Wilmington Hospital, and still exists today . The Homeopathic Hospital 1888 became Memorial Hospital, then Memorial Division in 1965, and closed in 1985 . The Physicians & Surgeons Hospital 1908 became Wilmington General, then General Division in 1965, and also closed in 1985 . The latter two merged with the earlier one in 1965 to create Wilmington Medical Center and the two were later replaced by Christiana Hospital, now all are incorporated in Christiana Care . Their respective nurses’ training schools merged in 1965 to create the Nursing School of Wilmington which also closed in 1985 . St . Francis Hospital operated a school of nursing based on strong Catholic morals and values . It opened in 1924 in the former Hilles Mansion and saw its first graduating class in 1927 . The last class of 21 students graduated in 1976 when the school closed . Delaware State Hospital at Farnhurst opened their nursing school in 1929 with the philosophy of preparing nurses to better care for mentally ill patients . Milford Emergency Hospital (later Milford Memorial Hospital, today Bayhealth Milford Campus) also opened a school of nursing in 1921 to train nurses to deliver nursing care to a southern Delaware patient population . All four would close during the 1970-80’s era when hospital-based schools of nursing would drastically decline and transition to university- and college-based basic RN programs offering degrees instead of diplomas . Beebe Hospital in Lewes would not be built until 1916 and would open their nursing school also in 1921 . It continues to educate nursing students today and is Delaware’s only hospital-based school of nursing . (See N . Hall and K . Pickard‘s article about diploma schools in this issue .) All other hospitals and schools would follow many years later . While the University of Delaware in Newark, Delaware State University and Wesley in Dover, and Goldey-Beacom in Wilmington were open to students in 1911, they did not grant degrees in nursing . Wilmington University would not even be founded until 1968 .
Where did these nurses work?Most nurses worked in private duty, not in
hospitals . Remember the hospitals had free apprentice labor for 3 years; the students would then
graduate, only to be replaced by the next cohort of students . There were jobs in hospitals for nurses as supervisors/instructors . Many would take jobs as private duty nurses in homes of wealthy patients . Those patients that could not afford private duty nurses would be patients in the hospitals to be taken care of by the students . Most nurses would work in private duty for a few years, leave to start or raise their families, and then a few would return to the hospitals as those supervisors and head nurses to supervise and educate the students . A few found employment in the TB sanitariums or the visiting nurse agencies . Most would never return, but elected to remain homemakers .
What did these nurses do? Nursing skills remain much the same: bathing,
assessing, diet, inserting a Foley, giving an enema, injections, medication administration, and documentation, only the instruments and tools have changed . Auscultation was being performed, the monaural stethoscope had been replaced by the binaural stethoscope in the 1880’s; the silver metal catheter (a sound) had been replaced by a flexible latex one (the Foley) and then a silicone one due to latex allergies, and flexible tubing and a bag had replaced the enema syringe . While many of the skills and treatments were similar, one can rest assured that nursing diagnosis did not exist, medical diagnosis was the guiding force, and the physicians’ orders were the plan of care to be followed without question . Critical thinking and evidence based practice were not buzz words yet, but the physicians stated that they wanted educated nurses who could solve problems in their absence . Many medications that we use today were already being used, but not the most important ones, antibiotics . Isolation, prevention, and some vaccines were in use . Smallpox, yellow fever, and malaria were under control, but polio, measles, and influenza were not . With the understanding of germ theory, sterilization and antiseptics in the 1870’s, surgery was now being used and decreasing what were previously 100% fatal conditions, like appendicitis . Some nurses were finding employment as: “instrument passers” and anesthetists in the OR .
Nursing had a long way to go, but as a profession it had already come a long way since its birth in the 1870’s . This author, like many nurses, but unlike some contemporary nursing historians and writers, recognize the birth of nursing as 1861-1865, or the American Civil War . If not the birth, then most certainly it was the catalyst that initiated the birth . Florence Nightingale laid the groundwork for nursing in the 1850’s through her nursing in the Crimean War, her research of hygiene and ventilation, and her statistics to prove that hygiene and hospital design did make a statistically significant difference . Her political action made the British government change their policies and drastically decreased the death rate of their soldiers from 40-60% to 2 .2% . She then disseminated her findings through her writings, first in England, and then in America in 1860 . (See L . Derickson’s article about Florence Nightingale in this issue .) The following year, 1861, exactly 50 years before 1911, the Civil War began and the healthcare demand was overwhelming . Over 200,000 men would die of battle wounds and another 420,000+ would die of diseases . A limited number of surgeons, Hospital Stewards, male detailed nurses, female paid nurses, and female volunteer nurses would attempt to meet the huge demands of sick and wounded soldiers in a time of limited medical knowledge . (See W . Campbell’s article on Hospital Stewards in this issue .)
Nursing has come a long way since 1911 and the founding of DNA . It has journeyed an even further distance since Nightingale of the 1850’s, Hospital Stewards of 1861-65, and the opening of nursing schools in the U .S . in 1873, the diploma schools of the late 1800’s and early 1900’s, and the military nurses of WWII (1941-45), but the journey will continue with the progress, the challenges, the triumphs, and the changes .
The reader is left with this quote, very much abbreviated from its original 2 pages, “we have followed the development of nursing…to the rather highly organized, widely varied, and expert forms of nursing service represented by the profession of nursing…today . We have noted how other powerful forces and movements…have acted and reacted on the development of nursing, helping direct its course and modify its character . In the face of almost overwhelming difficulties, hampered by every kind of restriction, beset by all the forces of ignorance and superstition, we have seen how untiringly they [nurses] labored, clearing away the obstructions in the path of progress, and building the foundations on which our work of the present day rests .” Modern day, 2018? No, the book: A Short History of Nursing by Dock and Stewart; the publication year: 1920!
William T. Campbell, EdD, RN
See Guest Editor for complete bio on page 1
(Excerpted from the Keynote Address at the Delaware Nurses Association’s (DNA) 2011 Spring Conference, April 7, 2011, in Newark, DE on occasion of DNA’s 100th anniversary .)
Let’s spend some time reflecting on nursing, our profession, our accomplishments, our concerns, and the many changes .
It’s interesting to take time and reminisce some days, when we have time, about what has changed since we graduated from nursing school, and what has not . The changes have a way of sneaking up on us . It’s not just reusable scissors, posey keys, and glass thermometers; it’s the whole profession of nursing that some days seem to have changed and other days to never change . If you graduated in the past 5, maybe 10 years, you probably have no idea what I’m talking about (“posey keys, etc”), but if you graduated 30 or 40 years ago you may remember some of these: white uniform dresses, white hose, white uniform shoes, nursing caps, the capping ceremony, white pocket protectors, Flowmeter labels actually used for timing IV infusion, Clinitabs, or no gloves . The units of measurement have even changed: minims, drachms, grains, and even cc’s have been discarded . What about all those abbreviations: QD, QOD, QID, QAM, QPM, QHS, TID, BID, PC, AC, LOC, or DC . Now the Joint Commission – or was it JCAHO – even the name of the change agent changed – says we can’t use those . How about LOC? - level of consciousness or laxative of choice? Or DC? - discharge the patient or discontinue the med? How confusing . Maybe that’s the reason for the changes . Now it’s the same words and meanings – it’s just spelled out instead of abbreviated . In some cases it’s just a different abbreviation for the same thing – ECG, not EKG, ED, not ER, and before that the “accident room .” Change means progress, but some of the changes predate some of us . Remember (or not) when you literally had to crank the head of the bed up, not just push a button . Remember when you had to repeatedly pump the rubber bulb on the sphygmomanometer to take a BP, not just push yet another button . Before that were changes many of us have never seen except in photos and museums . How about: iron lungs for polio victims, invalid feeders for clear/full liquids, porcelain bedpans, bandage rollers, lint scrapers, chatelaines, thermometers that were in cases pinned to the nurses uniform and used for every patient on the ward, or a glass syringe in a case with two needles that were cleaned between patients and occasionally resharpened . Change is everywhere . In 1911 when DNA was formed it was no different . There had already been many changes in the profession and there would be many more in the next 107 years .
What was happening in nursing in America and in nursing in Delaware in 1911?
1911 was a time of change in nursing . The Spanish American war had ended and had created a demand for nurses for the first time since its birth in the last war in the 1860’s . The Army Nurse Corp was organized . The American Red Cross had recently been organized by Congress and Clara Barton as their first president was still alive . Florence Nightingale had just died 4 months previously . State registration and licensure for nurses was being developed . Minimum standards of nursing education were being debated . Higher education in nursing was appearing in a few universities such as Columbia Teachers College . Government social services including nursing and nursing specialties were new and growing concepts . More women were going to school, delaying families, and starting professional careers .
It was a time of social change and social unrest . Segregation was strong . Nursing was a profession for white unmarried females . Minorities felt socially and professionally isolated . Males could not attend most nursing schools and had their own schools . Males could not work in hospitals except for the insane asylums . They could not be nurses in the military; that discrimination would continue until well after World War II . Trained and licensed male nurses entering the military had to work as medics or pharmacist mates, not as nurses, until 1954 . (See C . Campbell’s article about nurses in WWII in this issue .) African American nurses could not attend the same schools or work in the same hospitals as whites . They could contract for private duty and care for white patients in their homes, but could not eat a meal with the family whose home they were employed in . Males were 6% and African American females composed 4% of all nurses . Both minorities would drop to 2% during the 1950’s and 60’s, but have increased slowly since then .
In this time of change and professional progress, Delaware Nurses Association (DNA) was organized
Page 6 • DNA Reporter August, September, October 2018
In Harm’s Way – Nursing in World War II
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
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 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 ccampb@comcast .net
Carlene J. Campbell
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/
ReferencesArmy 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 TrialsNicole Hall, EdD, MBA, RN, CNE
and Karen Pickard, MSN, RN, CNE
Dr . Hall earned her nursing degree from Sa l isbur y Universit y 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 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 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 .
Nicole Hall
Karen Pickard
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 .
ReferencesBeebe 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. Retrieved from http://www .nln .org/docs/default-source/newsroom/nursing-education-statistics/number-of-basic-rn-programs-total-and-by-program-type-2005-to-2014 .pdf?sfvrsn=0
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Page 8 • DNA Reporter August, September, October 2018
Lynn Derickson, EdD, MS, RN, CNE
Dr . Derickson is an Associate Professor of Nursing at Wor-Wic Community College in Salisbury MD . She is a Lieutenant Colonel (Ret) Maryland Army National Guard, is a member of the Maryland Nurses Association and has served on the Maryland Board of Nursing .
A Case for Going with “Flo”: Why Modern Nursing and Nursing Education Should Embrace Florence Nightingale
Lynn Derickson
Many nurses today would cower at the atrocities and shunning that Florence Nightingale endured during more than 50 years of efforts to make the world a better place . Ms . Nightingale felt her calling at an early age to serve those who had no voice and defied the social norms of her station to do so (“Information and Articles,” 2014) in order to further her belief that equal and competent health care were basic rights for all people (Selanders, Lake & Crane, 2012) . Her achievements have been vilified, minimized, and ridiculed over the last 150 years (Tye, 2011; Thorp, 2015) . Even so, history bears witness to her contributions to modern nursing and healthcare . Many of the concepts taught in nursing programs and practiced by nurses were first identified as important by Ms . Nightingale .
In their nursing education, students are instructed in the basics of documentation, infection control, nutrition, patient education and empowerment, the importance of effective and efficient care, teamwork, and triage . These are themes that Ms . Nightingale identified as important to health care delivery and practice (Tye, 2011) . Where in nursing education curricula are students taught how this was identified as being important and why? Let us look at each .
Documentation, and the importance of keeping accurate medical records, is important not only for legal reasons, but so there is a record of what was done and what may have resulted in a complication, or that we can identify changes that are needed in our systems . It is profoundly important that nurses accurately observe and record changes in patient conditions . Florence began doing this in Scutari, so that symptoms, treatments and reactions to treatment could be accurately assessed (Tye, 2011; Nightingale, 1992) .
Infection control is taught from the fundamental courses in nursing education programs, but do students know that it was Florence who demanded cleanliness in hospitals? Prior to Florence’s teaching, the mortality rate was
42 .7%; infection control practices reduced the mortality rate to 2 .2% (Payne, 2010), all without knowing anything about germ theory . She also supported the revolution of hospital design, endorsing the pavilion-style (Campbell, 2017) which prevented as much traffic as possible from passing through patient wards and allowing for light and fresh air . This innovative design maximized cross ventilation to decrease infectious diseases . It is as important to know why nurses do something as it is to know what nurses do . This enables us to look at practice and change outcomes .
Nutrition was identified as a basic need by Florence at a time when the poor and the lower ranking military men were given scraps left over from the wealthy and from military officers (Tye, 2011; Nightingale, 1992) . While this is taught in nutrition and fundamental nursing courses, are students taught why and how this was discovered? To do something and not know why, or what the outcome would be without doing it, is practice without science .
The patient centered care movement of today is a result of Nightingale’s efforts to provide her patients with an alternative to negative habits . She provided soldiers with an alternative to drinking away their pay . A library was established for them, and they were guaranteed that their pay would be sent home to their families (Tye, 2011) . Today’s nursing education programs focus on teaching-learning outcomes and having the patient leave the hospital, rehab, or home care well informed as to their treatment . Today, nurses provide patients with choices and alternatives to treatments and interventions that will empower them to control their health outcomes .
In nursing education programs, students are taught about effective and efficient patient care and how to use the least amount of resources to accomplish the most positive outcome . This reduces cost per patient per day . Every system uses a supply system that is a well-run and efficient materials management system . This began with Florence Nightingale (Tye, 2011; Berman, Snyder & Frandsen, 2016) . These concepts are taught in nursing leadership and management courses and students should know this came from Florence’s work .
From entry into nursing programs, students are taught about collaboration and communication, working with multiple team members, as well as other nurses to achieve a positive experience and outcome for patients . Florence was the first to encourage this, prior to which, there were providers at conflicting odds and frequently in disagreement with one another . In a letter to nursing students at the Nightingale Training School, Florence spoke of “…backbiting, petty scandal, misrepresentation, flirtation, injustice, bad temper, bad thoughts, jealousy, murmuring, complaining . Do we ever think that we bear the responsibility of all the harm we do in this way” (Tye, 2011)? Bullying and incivility are ‘hot topics in today’s nursing environment, nursing education, and in hospitals (Cohen and Bartholomew, 2008; Derickson, 2012; Lupparel, 2003) . We bear the responsibility for extinguishing this blight on our profession and it begins in nursing education .
Most nurses give credit for developing triage systems to the military . Indeed, military medicine should receive credit for the improvement of triage systems . However, it was Florence Nightingale who first developed a basic triage system so that all would be considered equally according to their need (Tye, 2011) . As students go through rotations in the emergency rooms and participate in disaster training, they should be taught how the systems used today came about .
In a study of evidence-based practice (EBP), Campbell (2017) found that “in the 1850’s FN [Florence Nightingale] used most of the steps of EBP, within limitations of the period, to identify and support her conclusion for the best hospital design: the pavilion-style hospital .” Also, “in the 1850’s she researched and disseminated her best practices for improving patient outcomes” (Campbell, 2017) . This is a real-life example that can be shown to students demonstrating the concept of EBP that was used over 150 years ago and still used today .
“In the 1880”s, Nightingale wrote that it would take 100 to 150 years before educated and experienced nurses would arrive to change the health care system . We are that generation of 21st century Nightingales who have arrived to transform health care and carry forth her vision…” (Dossey, 2010, p . 15) . It is up to us to keep her vision alive, by giving it to future generations of ‘Nightingales’ .
ReferencesBerman, A ., Snyder, S . & Frandsen, G . (2016) . Kozier and Erb’s fundamentals of nursing:
Concepts, process, and practice. 10th Ed . Boston, MA: Pearson .Campbell, W . T . (October 9, 2017) . Early evidence-based practice (EBP): Florence
Nightingale and the pavilion-style hospital . Poster presentation at the Sigma Theta Tau 2017 44th Biennial Convention . Retrieved from: http://hdl .handle .net/10755
Cohen, S . & Bartholomew, K . (2008) . Our image, our choice: Perspectives on shaping, empowering, and elevating the nursing profession. Marblehead, MA: HCPRo .
Derickson, L . M . (2012) . A study of the live experiences of newly licensed nurses (Unpublished doctoral dissertation) Wilmington University, Wilmington DE . (Available from: ProQuest UMI number: 3490080) .
Dossey, B . M . (2010) . Holistic nursing: From Florence Nightingale’s historical legacy to 21st century global nursing . Alternative Therapies, 16(5) .
Luparell, S . (2003) . Critical incidents of incivility by nursing students: How uncivil encounters with students affect nursing faculty. (Doctoral dissertation) Retrieved from ProQuest (AAT3092571) .
Information and articles on Florence Nightingale: A famous woman in British history . (2014) . Retrieved from http://britishheritage .com/florencenightingale
Nightingale, F . (1992) . Notes on nursing: What it is and what it is not. (Commemorative Edition), Philadelphia, PA: J . B . Lippincott Company .
Payne, K . (2010) . Science, healing, and courage: The legacy of Florence Nightingale . The Alabama Nurse, 37(3) Retrieved from https://www .thefreelibrary .com/Science%2c+healing%2c+and+courage%3a+the+legacy+of+Flore://britishnce+Nightingale .-a0229860985
Selanders, L ., Lake, K . & Crane, P . (2010) . From charity to caring: Nightingale’s experience at Harley Street . Journal of Holistic Nursing, 28, 284-290 .
Thorp, D . J . (2015) . Betsi Cadwaladr: A Welsh nurse in the Crimea . Online book retrieved from: https://www .amazon .in/Betsi-Cadwaladr-Welsh-Nurse-Crimea-ebook/dp/
Tye, J . (2011) . The mother of all hospital administrators . Hospital and health networks. Retrieved from: www .hhnmag .com/articles/5011-the-mother-of-all-hospital-administrators
August, September, October 2018 DNA Reporter • Page 9
The Hospital Steward: His Relationship to Nursing
William T. Campbell, EdD., RN
See Guest Editor for complete bio on page 1
During the American Civil War (1861-1865) there was a military medical position called the Hospital Steward . Most Civil War enthusiasts would define this individual as a “workhorse .” While this position does not exist today as a single individual, at the time of the Civil War this man was commonly seen as the druggist/chemist (pharmacist today) and the hospital administrator . This author believes he was more closely related to nursing .
To better understand the Hospital Steward, it is best to read the primary reference on this position written by J .J . Woodward . The Hospital Steward’s Manual: For the Instruction of Hospital Stewards, Ward Masters, and Attendants in their Several Duties, published by Lippincott & Co . in Philadelphia in 1862 . Dr . Woodward was an Assistant Surgeon in the US Army . In the manual, Woodward (1862) stated the medical qualifications of this applicant: “must have…sufficient knowledge of…pharmacy to take charge of the dispensary, acquainted with minor surgery, …application of bandages and dressings, extraction of teeth, application of cups and leeches, …knowledge of cooking” (p . 20-21) . One should note that the qualifications are much broader than just pharmacy . The manual not only included the roles and responsibilities of the Hospital Steward, but also continued in later chapters to include hospital attendants and nurses .
The Hospital Steward was selected and appointed to his position and title . In contrast, the male nurse was usually temporarily detailed from inexperienced enlisted men . Woodward’s (1862) qualifications included “18-35 years old, able-bodied, free of disease… honest and upright”, of “good intelligence, having a knowledge of English, able to spell and write …correctly”, and “industrious, patient, and good tempered” (p . 20) .
The roles and responsibilities of the Hospital Steward were numerous . In the hospital and acting as the pharmacist, he compounded (measured and mixed) prescriptions, rather than just filling them from a bulk supply . The Hospital Steward also verified that the medication was actually administered although he was usually not the person who gave it . As Hospital Administrator, he was responsible for inventory and ordering of medical supplies, hospital supplies, record keeping, and overall hospital administration . It included the Steward’s Weekly Report, an enormous spread sheet manually recorded . On it were recorded weekly the number of beds, linen, clothes, dishes, and even spittoons .
In addition to the roles and responsibilities previously mentioned, Woodward listed one other responsibility . The Hospital Steward was to be the Nursing Supervisor for the male detailed nurses (enlisted men) . Woodward (1862) stated: “enlisted men are under the orders of the surgeon…look up to as their commanding officer . . .are also under the orders of the hospital steward, to all whose lawful commands they must yield prompt obedience” (p . 30) . Gillett (1987) in The Army Medical Dept 1818-1865 also mentioned the tie between Stewards and nurses when she said “…the Hospital Steward, who before the [Civil War] often added the role of nurse to his other duties…” (p . 156) . Regarding the female nurses, Woodward stated “she should heartily co-operate with the steward, and strictly obey the orders of the medical officers” (p . 38) . While all female nurses were under the orders of the hospital’s chief surgeon, the paid nurses were also under the supervision of Dorothea Dix, but they were not under the supervision of the Hospital Steward .
In an attempt to gain insight into the roles and responsibilities of the Hospital Steward, this researcher has been able to locate eight primary sources by and about Hospital Stewards in addition to Woodward’s official manual . These sources give us a glimpse into the lives of these individuals during the Civil War years . These books were written by the Hospital Steward himself post-war or were edited from journals, diaries, and/or letters written by the Hospital Steward during the war years . Primary sources often allow us to see what the individuals are doing especially if their performance differs from the official manual . Only duties above and beyond those expected and mentioned by Woodward will be noted below .
Allen (2012) edited from the diary of Albert Ballou, Wisconsin Volunteers . He described conducting sick call, diagnosing, prescribing, doing minor surgery, treating smallpox, pulling teeth, and treating a urethral stricture . He stated “went to see some sick children outside the lines…have to attend the sick, doctor has gone…called on the refugees…gave prescription” (p . 141-42) .
Earp (2002) edited from the journal of C . Marion Dodson . Dodson served as a Union Navy Steward aboard three ships . He described how he was involved in diagnosis, treatment, minor surgery, administering chloroform, and prescribing medications . He volunteered to serve on a ship quarantined for Yellow Fever where the surgeon was ill and he was the sole provider . In addition he served on a second ship where he was also the sole provider . He stated he had a male nurse detailed to assist him . (Originally from St Michaels MD, he became a physician after the war with a practice in Baltimore MD and later retired back to St . Michaels .)
Flannery and Oomens (2007) edited from the journal of Spencer Bonsall, Pennsylvania Infantry . Bonsall commented in his journal on dressing wounds . He also listed autopsies as one of his responsibilities .
How are pharmacotherapeutic contact hours calculated and awarded?Pharmacotherapy is that area of practice that is responsible for ensuring
the safe, appropriate, and economical use of drugs in patient care .Content eligible for meeting criteria for pharmacotherapeutic credit includes:
1 . Overview of the disease or disease process for which medication therapy is required (context for appropriate medication therapy)
2 . Scientific rationale or evidence-base of the use of medication therapy for a disease or disease process
3 . All content related to prescribing/recommending safe and appropriate use of medication therapy, including cost-effectiveness
4 . All content related to the safe administration of medication therapy, including but not limited to dosage, route, frequency, delivery devices, administration devices and similar
5 . All content related to monitoring of medication therapy6 . All content related to possible side effects and/or adverse effects of
medication therapy7 . All content related to special considerations related to medication therapy8 . All content related to adjunct therapy that may be used in conjunction
with medication therapy
Are the uses of nonconventional sellable products allowed in educational activities?
It is important to investigate the use of the product by asking questions such as
• Is it used on a patient or for nursing professional development (anything related to the nurse being able to do their job)?
• Is it used on or consumed by the patient?• Are the products sold in a primary office or medical practice?
Keep in mind the definition of a commercial interest organization and whether or not the educational activity is related to a commercial interest product .
How might an Approved Provider Primary Nurse Planner ensure that all Nurse Planners are appropriately oriented/trained?
Strategies that might be used for orientation or training could include but are not limited to: workshops, self-learning packets, webinars, monthly calls and/or mentoring, coaching and guidance .
Providing access to resources is critical . Nurse Planners must understand ANCC criteria and how it is applied to planning educational activities; therefore, the Nurse Planners must have access to individual educational activity information including educational design, requirements, and criteria .
It is not sufficient for the Primary Nurse Planner to only provide access to resources . The Primary Nurse Planner must ensure that new Nurse Planners understand how to use educational resources and apply the principles of high quality educational design when developing activities .
CE Corner
Approved Programs and Providers
Approval Number
Conference TitlePresentation
Date
18-01-01DSNA Winter Conference-Clinical Practice Updates
March 3, 2018
18-01-02Social Determinates of Health and Impact on Care
March 7, 2018
18-01-03 Sip and Sleep 2018 March 9, 2018
18-02-04 Lung Force Expo April 19, 2018
18-03-01 PROV Bayhealth Medical CenterApproved Provider
18-03-02 PROV VA Medical CenterApproved Provider
18-04-01Talking with Youth About Consent & Rape Culture
May 31, 2018
18-04-02STTI Beta Xi Annual Evidence Based Practice End of Year Dinner Meeting
May 7, 2018
18-04-03 Healthcare Theatre Workshop May 4, 2018
18-05-01 PROVNemours/Alfred I . duPont Hospital for Children
Approved Provider
18-06-01Appoquinimink School Nurses 2018-2019 Back to School
August 28, 2018
The Hospital Steward: His Relationship to Nursing continued on page 11
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Hyde (1900) wrote a book about his own experiences as a Hospital Steward with the Ohio Infantry . He was a prisoner in three different Confederate POW camps . At the third POW camp, Andersonville, he was in the hospital outside the prison walls where he was dispensing to civilians & families and was allowed to go out into the countryside to collect herbs . He not only survived Andersonville, but stated that he returned after the war with Clara Barton to help identify the thousands of unmarked graves .
Johnson (1917) wrote a book about his experiences as a Hospital Steward with the Illinois Infantry . He described and discussed medical care, medicines, surgery, and nurses . His book is a very descriptive narrative of the medical care that he saw the Surgeons deliver, but contains few details of what he personally was doing as a Hospital Steward other than assisting at Sick Call . He briefly mentioned nurses and at one point stated that he personally “nursed” and cared for a patient with typhoid .
Priest (1995) edited from the many letters and the diary of John N . Henry, NY Volunteers . He stated that he was assisting the surgeon with sick call . Henry also stated that he was called out to see sick patients independently and was called out to see a patient in an emergency . In relation to the importance of his position he stated “…any other person could leave (on furlough) better than I could…” (p . 376) .
Roper (2001) edited from the diaries of John Samuel Apperson of a Virginia Brigade . Apperson described dressing wounds and administering anesthesia . He also talked about seeing patients independently, diagnosing & treating, vaccinating for smallpox, collecting tissue samples, extracting teeth, performing autopsies & triage, attending the wounded, practicing percussion & auscultation, and being an apprentice to a surgeon . At one time he went into the community to do minor surgery on a child’s neck and open an abscess . On other occasions he was doing surgery on gunshot wounds, amputating fingers, amputating below the knee, and removing a bullet from a foot .
West (2010) edited from 230 letters and the diary of Daniel McKinley Martin, Virginia Infantry and West Virginia Cavalry . Martin referred to himself as the “tooth puller .” He stated he “vaccinated (for smallpox) perhaps 100 of our regiment today” (p . 207) and on another occasion mentioned “…how many operations I assisted with the doctor in performing I can’t tell…” (p . 114) . For a period of time the surgeon went to Baltimore and Martin was “the only surgeon left with the regiment…I have to prescribe and dispense the medicines…” (p . 100) .
After reviewing the primary sources it is obvious that the roles and responsibilities of the Hospital Steward far exceeded those that Woodward penned in his official manual . It could be that an individual overstepped his role, but yet some of the same themes appear from different Stewards . The reader sees mention of diagnosis, treatments, prescribing medications, administering vaccinations, performing minor surgery, and administering anesthesia . The most important repeated theme is autonomy or practicing independently . This theme of autonomy is repeated throughout the primary sources in a military setting that was typically anything but autonomous . If one were to compare the Hospital Steward’s roles, responsibilities, and duties along with his level of autonomy to modern day healthcare, a similar individual can be identified . Those individuals are Advanced Practice Nurses (APRN), either Nurse Practitioners (NP) or Certified Registered Nurse Anesthetists (CRNA) or maybe Clinical Nurse Specialists (CNS) . While Woodward identified the Hospital Steward as a combination of Pharmacist and Hospital Administrator and Nursing Supervisor, based on primary sources one could add to the list the first APRN/NP/CRNA . He really was a “workhorse .”
ReferencesAllan, Alice (Ed .) . (2012) . He said: Diary of a Civil War
Hospital Steward. (self published) .Earp, Charles (Ed .) . (2002) . Yellow Flag: The Civil War
journal of Surgeon’s Steward C. Marion Dodson. Baltimore: Maryland Historical Society .
Flannery, Michael, and Oomens, Katherine . (2007) . Well satisfied with my position: The Civil War journal of Spencer Bonsall. Carbondale, IL: Southern Illinois University Press .
Gillett, Mary . (1987) . The Army Medical Department 1818-1865. Washington DC: Center of Military History, United States Army .
Hyde, Solon . (1996) . A captive of war. Shippensburg, PA: Burd Street Press .
Johnson, Charles Beneulyn . (1917) . Muskets and medicine or army life in the sixties. Philadelphia: F . A . Davis .
Priest, John Michael . (1995) . Turn them out to die like a mule: The Civil War letters of Hospital Steward John N. Henry, 49th New York, 1861- 1865. Leesburg, VA: Gauley Mount Press .
Roper, John (Ed .) . (2001) . Repairing the march of mars: The Civil War diaries of John Samuel Apperson, Hospital Steward of the Stonewall Brigade, 1861-1865. (Jason Clayman, Peter Gretz, and John Herbert Roper, Trans .) . Macon, GA: Mercer University Press .
West, Alan I . (2010) . Remember me: Civil War letters home from a Hospital Steward 1862-1864 Daniel McKinley Martin. Chicora, PA: Mechling Bookbindery .
Woodward, J . J . (1862) . The hospital steward’s manual: For the instruction of hospital stewards, ward masters, and attendants in their several duties. Philadelphia: Lippincott .
The Hospital Steward: His Relationship to Nursing continued from page 9
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