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19

THE FUTURE OF NURSING

On November 5, 1928 I was in Berlin with four hours to spend between
@ traln that had brought ma from Latvie and 2 train thet was to take me to Paris.
I went. over to the Adlon Hotel to read the Paris edition of the New York Herald,
and find out who had been elected President of the United States. It was
Herbert Hoover.

Moments of relative idleness ocensionally pay eingular dividends.

For some reason or other it occurred to me that it might be fim to vaste an
hour or two writing down a forecast of what kind of a President Herbert Hoover
vould make. 80 I took a few sheets of Adlon stationery and sterted to write
cut in ectual sentences what I thought would heppen.

The results vere entirely unexpected. J eti2l1 heve that forecast but
if I were to read it your attention would be deflected from facte that ere far
more important than elther the accuracy or the comprehensiveness of that prophecy.

My Myrst surprise was that I hed teken more paper than I eould fill.
I thought I had auite a lot of clear idess to put down. But when it came to
making actual sentences of them with subjects and predicates, with simple nouns
and verbs, adjectives and adverbs, I did not heve so mich to say even though I
was free from the obligation to stick to facts, and could stete mere surmises
and suppositions.

The next fact that became evident, and impressive in its obviousmess,
has steyed with me, and will stay with me for the rest of my life, It 16 quite
simple: if you want to find out how ttle you lov about a situation, Just
sit down and try to put on paper whet you think explicitly its future develop~
ment will be. The immedinte and overwhelming result is thet you find yourself
more lamentahly lscking in Imowledge than you could possibly heve realised from
any other oxercise of your mind. You find yourself writing a virtual index of
your ignorance. You find yourself saying, "But before I comait myself on
point XT would have to kmow a good desl more about points A, B, and C. And I
don't know enough about A, B, and € to gay anything st all." In shert, you
find yourself putting down a thole array of really consequential questions.
Aren't questions important?

It is reported ~ nt I will nowt vouch for the authenticity of the
story - that in her last hours Gertmide Stein, wakening from a period of drowal-
ness, suddenly sat bolt upright and called out loudly, “What is the answer?

What is the answer?" Mise Toklns coming into the room and seeking to canfort
her seid, "There iem't any answer." “Then what is the question?® cried Gertrude
Stein and fell back, dead.

It was said of Franklin Roosevelt that even if he did net imo the.
right answer to many questions he mew the richt questions to ask.

In any event, if you try to forecast the future you will find yourself
agking a more serious and significant set of questions then you would other~
wise think of putting together.

The third fact that I began to learn in the Adlon Hotel ia that if
you ever want to get interested in the development of something, just try writing
down what its future will be. I watched Hooverts sareer with redoubled interest
because I tried to foretell it.

I shall not explore another aspect of forecasting, namely, that such
sciences as astronomy, which cannot prove their theories by laboratory experi~
ments, go far toward establishing the value of their theories by testing the
aceuracy of thelr predictions. Indeed the teat of accurste predictability is
a eriterion valuable to ecientists, and may, I think, be strongly recommended
te such social sciences as lack experimentel opportamities to test their theories.
In medicine we use it, but we sometimes ignore the salutery discipline imposed
3

pen ua as dectors and nurses by the desands for saus sort of prognosis. We
could usefully apply prognosis to our om professions.

I have tole you this story ahout trying to predict the course of
Hoover's administration beccuse if you want to leam more about mursing and
thoroughly enjoy watching lis developsent from now on, then tcke a few sheets
of paper and plenty of time and foree yourself to commit yoursell to some good
clear statenants on the future of nursing. Trom thet exercise you will get
the desire to flad enawers te the most reuarkebly consequential and significant
questions. and you will have «a contimuing interest in the field as Lit develops.

Most speakers have to work harder than their uudlences. But most
speakers talk about the past. My subject is the Future of Nursing and this
may justify me in righting eu ancient wrong by suggesting that you can work as
hard as the speaker, Indeed, that any exciting and useful knowledge you can
obtain about nursing must be secured by your own effort in setting down your
avn forecast of the Future of Nursing. I urge you to de this. How right your
precictions mny prove to be will seem quite secondary; It 1s the by~products
that wlll bring your restless interest end lasting satisfaction.

Perhaps I ove you some measure of example along with so much precept:
and exhortation. So I will list, not for your edification, but for your
orktical exemination, some of the questions whose answer might enable one to
forecast the Future of Nursing. And for the sake of definiteness let us aay
that the future aeens the next four decades - « period that would cover the
probabilities, if not quite the hopes, of everyone here.

fo forecast the future of any profession one would look first to the
demand and further to the need for the services it renders. In the case of
nursing, beyond the demand and the need lies the question of what is cur cur
rent and our future view of Lllness. We no longer regard sickness as Divine
Ae

punishment, or an act of God te refine cur characters by tribulation. We have
advanced from that stage but we haven't the right attitude even yet. In the
main we still regard illness and accidents as bad luck. But we are now begin~
ning to regard illness as at least a calculable risk to be provided for on the
insurance principle, and we are slowly learning that health and good medical
care can be provided by the use of foresight, effort and money. Merely this
new and growing attitude toward illness reinforces the belief that the need
for nurses will increase,

As health conditions aud medical care improve, the life span of the
individual will increase, his losses from iliness will diminish and thus the
urgency of good care when he does fall 111, will impress him all the more by
contrast. In other words, as iliness becomes less of a commonplace experience
it will receive more attention and importance in the minds of laymen. The
more illness 1s prevented and the better it is cared for the more effective
attention it will receive.

Is there any evidence for believing that the technical care of the
sick is becoming less exacting? Is medical science and the best care it can
provide becoming less intricate and precise? No, Therefore, the demand for
nureing competence will increase.

What is the present ratio of the number of nurses to the number of
doctors? Is it on the increase? Or the ratio of nurses to hospital beds ~
private, semi-private and open werd? Or the ratio of nurses to the population ~
urben and rural?

What can we learn for the future of mursing from studies ih the field
of medical economics? Is it not the part of commen sense to bear in mind con~
stantly the fall in the purchasing value of the dollar? Just how much of a
correction, then, should be made in all statenents of salaries, of hospital
5.

endowment income, of educational budgets? Is the nursing profession to blame
for the apparent increase in the cost of its services?

Is there any indication that the governnent has reached the peak of
its greatly increased programs in medical care? I have seen no evidence that
as veterans grow older they need less nursing, and the same factors will be in
operation if the proportion of elderly people in the population increases.

Now it ia particularly important to realise that as mass production
and assembly line procedures make manufactured articles amazingly cheap, the
cost of personal services becomes fer higher relative to the cost of things.
What would the figures show regarding the increasing cost of domestic servants,
administrators, hair dressers, or private tuters ~ all occupations in which
personel service is essential? ‘The cost of nursing care is increasing with all
other costs that involve personal care in contrast to work that can be done by
machines.

Since the answers to all these questions establishes the certainty
that nursing costs and the demands for nurses are growing let us ask if there
is any likelihood that nurses will be supplanted by any other occupational group.
Ia pursing os a profession likely to be taken over by men? If so, to what extent?

And what alternatives do women, young or old, have to nursing as a
career? Is the marriage rate increasing above the approximate 66 per cent of
girls from 18 to 22 who get married? And the divorce rate? And will women
enter in larger mmbers the ranks of wage earners in an increasing number of
callings or occupations? Must nursing in the future compete with more altema-~
tive careers or fewer? What proportion of ite ranks will nursing lose each year?

It has been characteristic of religious institutions for their staffs
to be underpaid and overworked. Will the hospitals rid themselves of this
heritage, in their ambition to become more businesslike in thelr methods?
6.

When shall we learn to pay for what used to be given in the name of charity?

Is the population still moving to the cities? What effect does that
have on the rural girl's choice of occupation? How rapidly is our population
increasing relative to the number of nurses?

If the future of these conditions that influence the number of nurses
neaded and available is a future where the supply will hardly equal the demand
can nurses solve the problem by reorganizing their methods of work? Already
there are several rather different kinds of nurse's work: Hospital, public
health and visiting nurses, private duty, work in doctors! offices, industrial
work, teaching, and the housekeeping, clerical, and general work that could
more economically be assigned to ward maids.

What are the proportions in each of these fields, of nurses with a
college degree, of nurses from a three~year nursing school that followed high
school, of nurses with one year or less of experience in nursing? What are the
trends? What ere the needs and what does the public seem willing or able to pay?
Or to provide in lieu of salaries? When will the public realize that the cost
of medical care ranks with food, houses, and clothing as one of the major
reguisites for staying alive? And who is effectively at work to show the
public this crucial glimpse of the obvious?

We cannot deal with nurses as though we were disposing soliders in
battle lines. They are free to leave nursing if they please. Then what are the
incentives and rewards of nursing going to be? What can be done to maintain the
present high status of a well-trained professional. nurse? Are medical students
being taught to appreciate the professional importance of nurses and how to
work with them effectively? Why not? Whose fault is it if the present gener~
ation of doctors are bewildered at the lack cf nurses? Does new hoepital con-
struction show ever increasing understanding of the importence of labor~saving
Fe

devices for nurses? If housewlves find housekeeping easier tian it used to be,
why ls not that true of nursing? How frequently do hospital trustees ask for

and act on iaformation relating to this whole list: hours of work, vacations,
sick leave, free evenings, over—time, part-time employment, and retirement plans
for nurses. Do any other employers of nurses face in increasing measure these
reallties? Are nurses entering the social security group? Are there substantial
wage differentials to reward Increasing competence in nurses? Or is it unhappily
true that once a nurse no prospect for professional growth nor a reasonable reward
for it?

When will we wake up to the fact that the religious abnegation of
earlier years cannot be counted on now that we want a profession adequate in
numbers, experience, dependability and working capacity? Is there any evidence
that we realize that nursing is in economle competition with other careers?

And what of recruitment to the insufficient ranks of nurses? What are
the trends of the past twenty years in point of the numbers in tne general
population, of college women, high school graduates and grammar school graduates?
How many of each go into nursing? And what is the proportion of each smong the
various types of nurses ~ professlonal, registered and practical? What propor~
tion of entrants to nursing schoola drop out before they finish? What are the
reasons given? What may the other reasons be?

What is being done to put an end to the apprenticeship system and to
put a more attractive and reasonable form of education in its place? if nursing
involves teamwork and supervision, do nurses get any kind of instruction in the
peychological consideretions that are beginning to revolutionize industrial
management and other forms of administration? Why not?

te # & © He He He
8.

Such are some of the questions whose answers would enable each of
us to forecast the future of nursing. They are not all the questions. I have
deliberately left out some and unwittingly left out others.

Whether any one of us can regolve the problems of nursing seems
doubtful. But the iumediate and practical decision before eawh one of us is not
that. It is whether each of us cares to take a creditable hand in improving
the future of nursing. For this purpose at least I can prophesy individual suc~
gobs if you will tenaciously believe in great plans and high causes, in the
power of tuking the initiative, in the wisdom of making the direct approach, in
freedom from self-pity and above all in endurance. Yor that last, especially,

this 1s the sanest of all advice - ~ get plenty of sleep! For sleep prepares

us tor the morrow.