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Freitas 1.Pdf EVOLUTION OF THE PROFESSIONAL NURSING ORGANIZATION; DEVELOPMENT OF POWER by LORRAINE FREITAS, B.S.N., M.A.ED. DISSERTATION Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY THE UNIVERSITY OF TEXAS AT AUSTIN December 1986 EVOLUTION OF THE PROFESSIONAL NURSING ORGANIZATION; DEVELOPMENT OF POWER APPROVED BY SUPERVISORY COMMITTEE: Copyright by Lorraine Freitas 1986 ACKNOWLEDGEMENTS My sincere thanks and appreciation to all who have supported me through this long process. Many people in varying capacities made it possible for me to complete a study of this undertaking. I am especially indebted to the chair of my commit­ tee, Dr. Eleanor Crowder, whose knowledge, tireless patience and unending moral support made my endeavors meaningful and stimulating. Thanks are also due to the other members of my committee. Their ideas and sugges­ tions proved beneficial to my writing. My thanks also to the archives staff of Mugar Memorial Library at Boston University and Milbank Memorial Library at Teachers College, Columbia Univer­ sity, for their invaluable assistance in the research of archives material. Special thanks are extended to the American Nurses1 Association for the use of ANA historical material. The membership and organizational charts in Appendices A through G are used with the Association's permission. My warmest love and thanks goes to my friends and colleagues who encouraged me throughout my studies and iv whose tireless friendship supported me when I needed i the most. Their caring and understanding were "beacon in a long dark tunnel." I am most grateful for the support and encourage­ ment from my fellow faculty. Their patience and understanding during the past two years were most helpful. Lastly, special thanks goes to my family, espe­ cially my sisters, whose love, confidence, support and interest in my studies have been a constant sustenance I am especially grateful to my parents, Christine and Joseph, who though not present to see this completion, through their love and belief in me have made it all possible. v EVOLUTION OF THE PROFESSIONAL NURSING ORGANIZATION DEVELOPMENT OF POWER Publication No. Lorraine Freitas, Ph.D. The University of Texas at Austin, 1986 Supervising Professor: Eleanor M. Crowder An historical analysis of the evolution of the American Nurses' Association relative to its development was done. Concomitant to that historical evolution, Peter Blau's conceptual framework of power as a social relationship was analyzed. The issue of power of the nursing profession has been an ongoing concern to nurses. Early nursing lead­ ers believed that the most effective way to obtain power was through the formation of organizations for nurses. They also believed that collectively nurses could address such issues as self-regulation of nursing education and nursing practice. The attainment of this regulation would give to both the profession and the association power. Thus in 1896, the American Nurses' Association (ANA) was organized as the association to vi represent professional nursing in the United States. Today, it represents the largest group of registered nurses. Therefore, for purposes of this study, ANA was referred to as the professional nursing organization. The purposes of conducting this study of the American Nurses' Association were to: 1. Trace the evolution of the professional nursing organization (ANA) relative to the development of power 2. Illustrate structural changes and their effect upon the organization's development of power 3. Demonstrate the use of power to influence acceptance of controversial issues 4. Identify changes that have occurred within the organization to promote its power An analysis of ANA historical material from its inception in 1896 until 1980 was performed. The years 1896-1980 were divided into five time periods considered by the author to be critical. Data were analyzed within these time periods in light of socio-economic and polit­ ical factors impinging upon the profession. The historical data led to the conclusion that nursing leaders, working through ANA, were able to unite groups of nurses to work toward common goals despite vii controversial issues. Through structural changes, ANA was able to build upon its developing power base, thus strengthening the association. The data also showed that ANA was a multi-faceted organization which was impacted from internal as well as external concerns. Even so, ANA was not only able to build a strong national association but contributed to the strengthen­ ing of the state associations. Additionally, there was evidence that despite ANA's position on controversial issues such as the entry level for professional nursing and its economic and general welfare programs, ANA was able to gain support and implement those programs. Even when nurses had left the organization to join other nursing groups, ANA was able to work collaboratively with those groups toward mutual goals. viii TABLE OF CONTENTS ACKNOWLEDGEMENTS . iv ABSTRACT vi Chapter I. INTRODUCTION 1 Statement of the Problem Purpose of the Study Significance of the Problem to Nursing Definitions of Terms Methodology Focus of study Sources of data Analysis of data Assumptions Limitations II. REVIEW OF LITERATURE 17 Concept of Power Studies that measure powerlessness Studies that measure power Conceptual Framework III. LAYING THE FOUNDATION FOR THE DEVELOPMENT OF POWER (1893-1912) 57 Recognition of the Need to Organize Formation of Nursing Associations The American Society for Super­ intendents of Training Schools for Nurses Nurses1 Associated Alumnae of the United States and Canada International Council of Nurses The American Federation of Nurses Identification of Problems Lack of standardization of educational programs ix Chapter Inception of training schools Lack of uniformity of programs Lack of legislation for registration of nurses Need for journal Few Dedicated Women Power Analysis of the American Nurses' Association IV. STRUCTURING ORGANIZATIONS: SOLVING PROBLEMS (1913-1946) 95 Issues and Responses Nursing Education Standardization of educational programs NLNE Curriculum Committee Nursing Education Studies Educational status of nursing Nursing and nursing education in the United States The grading report Registrations of Nurses Improvement of Nursing Schools New Concepts in Education Problems with Graduate Nurses' Work Conditions Expanding Roles for Nurses Deteriorating Conditions Impact of Societal Conditions: Industrialization, the Depression and the Two World Wars ANA Structural Changes Basic entry unit Committee on revision of bylaws Registries Professional counseling and placement services Formation of bureaus National Headquarters Office Power Analysis of the American Nurses' Association x Chapter V. MATURING: FURTHER EVOLUTION OF THE ORGANIZATION (1947-1960) 133 Issues and Responses National Nursing Council Welfare Issues of Nurses ANA Programs Professional Counseling and Placement Services Intergroup Relations Program Government Relations Program Economic Security Program Reports of Studies of Nursing Service and Nursing Education A Program for the Nursing Profession The Brown Report National Committee for the Improvement of Nursing Services Community College Education for Nursing National Nursing Organization's Structural Studies Rich Report 1946 Convention 1947 Special Convention Tentative plan for one national nursing organization The 1949 alternate plans Power Analysis of the American Nurses' Association VI. CONTROLLING: DIRECTION OF PRACTICE AND THE PROFESSION (1960-1979) 173 Issues and Responses Standards of Nursing Education Basic nursing education Graduate education Continuing education Nursing Studies Community College Education for Nursing National Commission for the Study of Nursing and Nursing Education Standards of Nursing Practice and Nursing Services xi Chapter Certification American Academy of Nursing Credentialing Economic and General Welfare Program: Continued Growth ANA Structural Change Power Analysis of the American Nurses' Association VII. FORECASTING: POWER BASES FOR NURSING (1980s ONWARD) 240 Introduction ANA Social Policy Statement Standards of Nursing Practice Standards of Nursing Education Standards for Nursing Services Economic and General Welfare ANA-PAC Credentialing Center ANA Structural Changes Future Directions VIII. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS 269 Summary Conclusions Recommendations APPENDICES 313 A. MEMBERSHIP CHARTS FROM 1897-1916 B. RAYMOND RICH ASSOCIATES PROPOSALS FOR STRUCTURAL UNITS C. JOINT STRUCTURAL COMMITTEE PROPOSALS--194 8 AND 1949 D. MEMBERSHIP ORGANIZATION CHARTS-- 1952 E. ANA STRUCTURAL ARRANGEMENTS— 1964 AND 1966 F. AMERICAN NURSES' ASSOCIATION: STRUCTURAL UNITS, NATIONAL LEVEL--1975 G. AMERICAN NURSES' ASSOCIATION: MODIFIED FEDERATION MODEL--1982 xii Appendix H. COMPARISON OF ANA MEMBERSHIP AND ESTIMATED NUMBER OF GRADUATE NURSES/REGISTERED NURSES SELECTED BIBLIOGRAPHY 338 xiii CHAPTER I INTRODUCTION The issue of power of the nursing profession is one of concern to nurses. This concern has been present from the formation of the first two formal national organizations for nurses, the American Society for Super­ intendents of Training Schools for Nurses in 1893 and the Nurses Associated Alumnae of the United States and Canada in 1896 .''" The need for affiliation of nurses and the need for control of educational preparation was recog­ nized by early leaders of the nursing profession (Dock,
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