For almost all of its first seventy years of existence, what has become the University of Kansas School of Nursing existed as an appendage to the KU School of Medicine.
Operating under various names ranging from the “Training School for Nurses” and the “Department of Nursing” to the “Department of Nursing Education” and even sometimes the “School of Nursing” (at least in internal documents), from 1906 to 1974 the nursing program always reported to and was ultimately controlled by the dean of the School of Medicine.
All this changed on April 1,1974, when Nursing gained full school standing and became a core academic component of the comprehensive medical education institution that had come to be known as the University of Kansas Medical Center. The new designation was part of a larger reorganization at the Medical Center that also saw the establishment of the School of Allied Health and a reconfiguration of the School of Medicine.
The School of Nursing’s achievement of official autonomy had hardly followed an easy or straightforward path. Much like the nursing occupation itself, the School’s institutional progress required overcoming a variety of societal obstacles and cultural predispositions that had long consigned nursing to second-class status in higher education. But by the time this milestone was reached at KU, it was a reflection of the fact that nursing had been transformed from a vocation into a profession.
When the Nurse Training School at the University’s first Eleanor Taylor Bell Memorial Hospital in Rosedale began its existence in September 1906, it functioned administratively as a sub-unit of the School of Medicine. The dean of the Medical School hired the first superintendent of nursing, an employment practice that continued for more than six decades.
More than merely being under the control of the Medical School, initially the Nurse Training School operated primarily to provide the staff that would enable the functioning of the hospital and the clinical education of third- and fourth-year medical students. “We had to train our own nurses if we were to have our own hospital,” admitted Medical School dean George Hoxie at the time. The contributions from the so-called “pupil nurses” were essential both in terms of patient care and keeping the costs of running the hospital as low as possible.
Toward that end, Hoxie hired Pearl Laptad to serve as superintendent of nurses. In this position, she had responsibility for all nursing services provided in the hospital and for most of the instruction of the first class of six students that began in the fall of 1906. This combination of teaching and supervisory duties remained in place for a half century. Not until 1956 would the responsibilities of educating the nursing students be permanently separated from those of directing nursing care on the floors of each ward.
During the first forty-five years of its existence (1906-1951) the nurse training program primarily offered students a diploma at the end of three years of study and work. This document certified that the graduate nurses, as they were then called, were qualified to take the registered nurse examination instituted by the Kansas State Board of Nursing in 1913.
The method of teaching in these early years followed the apprenticeship model. Students were shown what to do, and then observed by supervisors or instructors as they repeated the procedures they had learned. Some content lectures by attending physicians filled them in on medical specialty areas.
On average, pupil nurses received six clock hours of instruction per week in a class setting and worked 60 hours a week in the wards. The nursing superintendent or her assistants observed student progress during their regular work hours.
By 1912, over their three years of study and work, nursing students had received 279 clock hours of instruction. This equated to about 18 semester hours of classroom instruction taken over the entire period of enrollment. At the same time, they worked 60 hours a week for 49 weeks a year. That meant they worked a total of 8,820 hours over three years. In compensation, they received a certificate of completion, free room and board, and a monthly stipend of between eight and fifteen dollars per month.
Altogether, the student nurses were more employees than students. Since most of their waking moments were literally on-call for nursing patients, the young women had little opportunity for socializing or personal time. Additionally, the male physicians of the Medical School set many of the expectations for the behavior of the nursing students. Beyond that, what the doctors did not specify was carefully laid out by the female nursing superintendents operating under direction of the deans of the Medical School. Strict decorum was to be maintained at all times among the nursing students on the hospital floor as well as in their residential quarters.
In some cases, such as during the administrations of S. Milo Hinch (1914-1920), and Henrietta Froehlke (1927-41), the nursing education program operated with a greater degree of autonomy, but this was more a function of Hinch’s and Froehlke’s relative longevity in office and their force of character than it was a matter of policy. Indeed, throughout this period, the Medical School leadership served as the administrative body in control of the nursing program.
During the tenure of Hinch, as Shirley Veith has pointed out in her 1988 PhD dissertation covering the first several decades of KU’s nursing education program, the dean of the School of Medicine and his fellow physicians placed “few restrictions…on her authority for the admission, instruction and assignment of duties of student nurses.” Indeed, Hinch was able to add a dispensary nurse to her other graduate nurse assistants in X-Ray and the operating theater. Still, this victory meant little more than that these four professionals plus the students provided all nursing services for the 25-bed hospital.
Administrative control became even more confused in 1915 when the members of the all-male Kansas Board of Administration (a state agency that had assumed the functions of the KU Board of Regents), directed that no new probationary student nurses be accepted because of cost considerations.
Hinch refused to accept this directive. She threatened to resign if she could not admit more student nurses to help with the duties of the hospital. Dean Mervin T. Sudler, who was the de facto administrative head of the Medical School at this time, could not promise this, so Hinch herself went to the Board of Administration. Ultimately, she won a half-victory. Hinch was permitted to admit new probationers, but only enough to replace those student nurses who had graduated or left the program.
In 1917, the nursing program received local accreditation from the Kansas State Board of Nursing. This first state accreditation increased the number of instructional hours required of nursing students in the program. It also proved essential to enable graduates of the Nurse Training School to use their certificates as qualifications for the state examination to become a registered nurse.
Even when, in 1922, the supervisor of nursing persuaded the dean to go along with improvements such as the hiring of additional nursing instructors to assist her, as well as additional teaching materials, a course in public health nursing and the construction of a nurses’ home, the request was turned down by KU Chancellor Ernest H. Lindley because of the extra expense. In this instance, the issue of being merely a component of the Medical School made no difference in whether the request was approved or denied.
In the early 1920s, teaching in the nurse training school was “an atrocious set-up,” according to a former student interviewed by Veith much later in life. At that time, Nurse Superintendent Martha Hardin had only one nurse instructor in addition to herself. Nurse training primarily taught students how to give baths, make beds and prepare dressings for patients. The remainder of the instruction occurred sporadically over the students’ three-year apprenticeship.
In 1925, the Nurse Training School established a basic rule that all applicants must have a high school diploma. Prior to this time, the majority of student nurses did have such preparation, but it was not required. The Kansas State Board of Nursing did not add this requirement to those for applicants seeking to take the registered nurse examination until 1933.
By the time Henrietta Froehlke became superintendent in 1927, the program had two assistants, ten supervisors and head nurses, and with five instructors. The Nursing School Committee setting rules and regulations for the program consisted of the superintendent and several Medical School faculty members. Nursing operated as a department within the Medical School.
With the establishment of the baccalaureate degree program in 1929, three-year and five-year tracks existed side-by-side.
According to the 1929 catalog, “The three-year course is offered at Bell Memorial Hospital, Kansas City. There is close correlation between the theoretical and practical work. Satisfactory completion of this course entitles a young woman to a certificate of nursing from the University of Kansas.”
The catalog went on to note that for the degree-seeking students in the five-year curriculum, courses “are the same as will be outlined for the three-year course…” except that BSN students did not have to repeat any classes they have already taken on the Lawrence campus. As long as the apprenticeship three-year program existed, nursing would be viewed primarily as a post-high school vocational training program by both the Medical School faculty and the Lawrence campus Arts and Sciences professors.
The major change came in 1951, when under the leadership of Professor E. Jean M. Hill, who served as department chair for Nursing, the three-year “diploma” or “certificate” program was phased out, leaving the baccalaureate degree track as the only path to obtaining credentials to become a nurse at the University of Kansas. This was an essential step in gaining recognition of the academic standing of the program within the Medical School and nationally.
In 1952, the KU Department of Nursing received its first national accreditation from the National League for Nursing Education. Initially, the department qualified for only “temporary” accreditation status, which meant that more refinement of the academic program had to be accomplished. Throughout the decade of the 1950s, Hill and her faculty altered much of the program to increase its academic content.
In 1956, in a major step toward defining the department as something other than a service agency for the Medical School, Hill gained approval to hire a full-time nursing service director. For the first 50 years of the nursing program’s existence, all academic superintendents, supervisors, directors or chairs also served as the chief nurse in charge of day-to-day nursing service throughout the hospital. With the permanent separation of duties achieved in 1956, Hill and her successors could concentrate fully on academic improvement.
In 1957, the Department of Nursing continued its upward path in sustaining national accreditation when it received “probationary” status from the National League for Nursing Education accrediting body. Full accreditation was achieved, effective as of December 15, 1959, and has been sustained ever since. In 2003, the School of Nursing switched national accrediting agencies and is now evaluated and approved by the Commission on Collegiate Nursing Education.
Throughout the 1960s, the Department of Nursing came to operate more and more independently of the Medical School. It added faculty members holding doctorates in nursing and related fields for the first time. The faculty also became more proficient, with specialized skills in various fields of instruction and scholarship.
At the same time, several related academic programs such as Dietetics, Physical Therapy, Audiology and Occupational Therapy, progressed in similar fashion to achieve academic recognition of their accomplishments and of their achievements in educating students in what were becoming separate disciplines nationally in the health professions.
As in most cases where formerly dependent academic departments seek independent status from the parent controlling entity, the 1960s and early ‘70s were marked by recurring struggles among the Nursing, Allied Health and Medical School faculties as each sought to establish or retain control over the nursing and non-medical coursework.
In her own official documents, the first dean of the School of Nursing, Hester Thurston credited her predecessor as department chair, Martha Pitel, along with herself as "instrumental in the movement from department to School status at KU."
The arrival of Executive Vice-Chancellor William Rieke in 1970 set in motion the specific events that led to School status for Nursing. In the fall of 1971, Rieke appointed a committee of faculty and students to study the best administrative organization for both Nursing and Allied Health departments. He stated, "Should this review lead to the conclusion that full collegiate rather than the present departmental status would best facilitate the accomplishment of the goals of Nursing Education, I am prepared to recommend to the Chancellor and our Regents that such a college or school be created."
Even while the review was ongoing in 1972, Rieke requested Nursing Chair Thurston to begin attending his bi-weekly meetings with deans and associate and assistant vice-chancellors. This conveyed effective inclusion of the highest-ranking administrator in Nursing in the central administrative body of the Medical Center as a whole.
Finally, on April 1, 1974, the Kansas Board of Regents approved the recommendation of the Medical School and University officials to designate the School of Nursing as one of three autonomous schools within the University of Kansas Medical Center—the continuing School of Medicine and the new Schools of Nursing and Allied Health. The deans of all three schools were henceforth to report to the executive vice-chancellor at the Medical Center.
By the time this distinction was made, the School of Nursing accepted no new faculty without master’s degrees in their field of specialty. Preference was given in hiring to those candidates with a Ph.D. or similar terminal degree.
While the School of Nursing must still jockey for position in the budget sessions with the other schools within the overall University of Kansas Medical Center, they have been fully in charge of their own destiny since the designation of separate school status in 1974.
William S. Worley
Adjunct Professor of History
University of Missouri-Kansas City