Lesson 1, Topic 1
In Progress

Factors That Influenced Practical and Vocational Nursing

May 1, 2021

Before 1860, nursing care in the United States was provided generally by people who were self-taught and who gained what knowledge they could through experience. Registration, licensing, and title differentiation were unclear or nonexistent. Duties and responsibilities were not clearly defined. The term nurse was used only in the broadest sense as “a person who takes care of the sick.”

The Need for Trained Caregivers

Practical nursing in the United States evolved from the need for caregivers who could be trained and ready for service in a short time. The cost of the services provided by these caregivers was expected to be reasonable and easily affordable by the patient. There was also the need to provide a vocation for the many unskilled women who were migrating to the larger cities to seek better opportunities. At the time, women generally were not skilled or trained for jobs other than manual labor.

World War I

World War I caused the need for trained nurses abroad to grow, and in the United States, the Spanish influenza epidemic strained the resources of the nursing community. The Smith-Hughes Act was passed in 1917 to provide vocational and public education. Federal funding then provided the means for vocational-based practical and vocational nursing programs throughout the country. Even with these resources, the demand for nurses caused by the war and the epidemic could not be met.

The Self-Taught Practical Nurse

By 1940, thousands of self-taught “practical nurses” were working to meet the needs of the country. They lacked the education and experience obtainable only under supervision in an established program. Few states had minimum standards for the practice of practical and vocational nurses. There was no agreement on the duties, the role, and the responsibilities of practical and vocational nurses, and they were known by many job descriptions and titles. The absence of standards and licensing created difficulties and safety concerns.

The state of New York was the first to have mandatory licensure laws. A state pool of test questions was adopted in 1945 by the State Boards of Nursing Examiners in 25 states (Smith, 2009). By 1950, all states had joined the momentum and required testing and licensure for entry into practice.