WEBVTT 00:00:05.130 --> 00:00:06.530 position:50% align:middle Hi. Good morning. 00:00:06.530 --> 00:00:08.450 position:50% align:middle And it's an honor for me to be here. 00:00:08.450 --> 00:00:12.980 position:50% align:middle And as an Irish-American, what a wonderful way to start this conference. 00:00:12.980 --> 00:00:18.230 position:50% align:middle I've never heard a conference started with such a wonderful way. 00:00:18.230 --> 00:00:22.970 position:50% align:middle So I'm already getting ideas for the conferences I'm going to this fall, that we ought to be doing 00:00:22.970 --> 00:00:24.750 position:50% align:middle something like that. 00:00:24.750 --> 00:00:30.600 position:50% align:middle So congratulations on your anniversary. 00:00:30.600 --> 00:00:38.470 position:50% align:middle And I was really pleased to see your 2023 conference theme, Shaping a Brilliant Future. 00:00:38.470 --> 00:00:44.240 position:50% align:middle As a historian, that really interested me, and I'll explain why in a minute. 00:00:44.240 --> 00:00:48.040 position:50% align:middle First of all, I want to thank you and your group. 00:00:48.040 --> 00:00:56.840 position:50% align:middle As a professor who's taught undergraduate professional issues nursing courses for decades, more than 40 years, 00:00:56.840 --> 00:01:03.610 position:50% align:middle I've been really always drawn to your organization's work, and it's helped me bring students' 00:01:03.610 --> 00:01:09.710 position:50% align:middle responsibilities to life for them in ways that they can really understand it. 00:01:09.710 --> 00:01:16.730 position:50% align:middle In fact, the historical research I'm going to talk about this morning, let me just grab the clicker here, 00:01:16.730 --> 00:01:24.080 position:50% align:middle was greatly enhanced by the work over the years that I have found on your website, 00:01:24.080 --> 00:01:27.800 position:50% align:middle and through the "Journal of Nursing Regulation." 00:01:27.800 --> 00:01:33.460 position:50% align:middle In specific preparation for this talk, I examined your most recent documents, 00:01:33.460 --> 00:01:37.550 position:50% align:middle your workforce study, and your one on the impact of COVID 00:01:37.550 --> 00:01:39.170 position:50% align:middle on nursing education. 00:01:39.170 --> 00:01:46.560 position:50% align:middle And I tried to analyze them through the lens of history and compare them to the regulatory work of our 00:01:46.560 --> 00:01:51.980 position:50% align:middle predecessors more than 100 years ago in the wake of the 1918 flu. 00:01:51.980 --> 00:01:57.660 position:50% align:middle And I want to argue that in order to shape that future that you're discussing at this meeting, 00:01:57.660 --> 00:02:01.350 position:50% align:middle you really need to have a sense of the past. 00:02:01.350 --> 00:02:04.970 position:50% align:middle And there's many quotes I could have pulled about the importance of the past, 00:02:04.970 --> 00:02:10.890 position:50% align:middle this just happens to be one of my favorites, the science fiction author, Robert Heinlein, 00:02:10.890 --> 00:02:17.330 position:50% align:middle the importance of really being able to use your past to think about the future. 00:02:17.330 --> 00:02:24.990 position:50% align:middle One enduring theme in history is that every major societal crisis, whether it's war, pandemic, 00:02:24.990 --> 00:02:31.950 position:50% align:middle economic collapse, has drawn attention to the need for nurses and that there are never enough of them. 00:02:31.950 --> 00:02:37.710 position:50% align:middle My colleagues at Penn Nursing and the Barbara Bates Center for the Study of the History of Nursing, 00:02:37.710 --> 00:02:46.430 position:50% align:middle Julie Fairman, Patricia D'Antonio, and I, decided to do this study in 2020 because of the 00:02:46.430 --> 00:02:53.800 position:50% align:middle so many debates that were happening early on in the COVID pandemic about the shortage of nursing, 00:02:53.800 --> 00:03:00.770 position:50% align:middle about temporary licensing for nursing, about trying to move nurses from state to state, 00:03:00.770 --> 00:03:06.480 position:50% align:middle and the meaning of licensing that we heard politicians and others think about. 00:03:06.480 --> 00:03:12.880 position:50% align:middle And in terms of the pandemic, there were lots of comparisons to that 1918 flu. 00:03:12.880 --> 00:03:18.090 position:50% align:middle Some of them were grounded in solid historical scholarship, but many of them weren't. 00:03:18.090 --> 00:03:23.740 position:50% align:middle And so we were lucky enough to apply for and secure funding to do this study. 00:03:23.740 --> 00:03:29.330 position:50% align:middle And here's the question that we asked, and it is a Pennsylvania case study. 00:03:29.330 --> 00:03:32.950 position:50% align:middle And as a historical research, it has no predictive power. 00:03:32.950 --> 00:03:38.890 position:50% align:middle So, of course, we couldn't predict the future and nor can it be generalized to other states 00:03:38.890 --> 00:03:40.690 position:50% align:middle outside of Pennsylvania. 00:03:40.690 --> 00:03:50.600 position:50% align:middle But what it can do is to look at unintended consequences made at a particular moment in time and 00:03:50.600 --> 00:03:54.710 position:50% align:middle learn from them to consider the future. 00:03:54.710 --> 00:04:01.020 position:50% align:middle So in order to appreciate how nurse regulation in the U.S. 00:04:01.020 --> 00:04:07.350 position:50% align:middle evolved in the context of that 1918 flu pandemic, you need to know a little bit about the back story 00:04:07.350 --> 00:04:11.160 position:50% align:middle of professional licensing in general in the U.S. 00:04:11.160 --> 00:04:17.470 position:50% align:middle And I'm going to start with medicine partly because it informed so much, 00:04:17.470 --> 00:04:24.500 position:50% align:middle it informed the template that we, in nursing, would use, but it also has such a surprising history 00:04:24.500 --> 00:04:27.630 position:50% align:middle that even most physicians don't know. 00:04:27.630 --> 00:04:34.990 position:50% align:middle In colonial America and early 19th-century America, local professional medical societies regulated who 00:04:34.990 --> 00:04:38.650 position:50% align:middle could and couldn't call themselves a physician. 00:04:38.650 --> 00:04:44.520 position:50% align:middle And by the early 19th century, multiple states enacted Medical Practice Acts, 00:04:44.520 --> 00:04:53.800 position:50% align:middle and then they were all thrown out in the 1930s under the presidency of President Andrew Jackson who argued 00:04:53.800 --> 00:05:03.970 position:50% align:middle against any kind of elite knowledge amidst a wave of popular movement of skepticism that any kind 00:05:03.970 --> 00:05:10.430 position:50% align:middle of specialized knowledge, especially those by so-called elites, was suspect. 00:05:10.430 --> 00:05:14.140 position:50% align:middle So for most of the 19th century, it was a free-for-all. 00:05:14.140 --> 00:05:16.660 position:50% align:middle Anyone could call themself a physician. 00:05:16.660 --> 00:05:21.110 position:50% align:middle Medical education in the United States could be a correspondence course. 00:05:21.110 --> 00:05:23.460 position:50% align:middle It could be an apprenticeship. 00:05:23.460 --> 00:05:27.070 position:50% align:middle It could be anything. 00:05:27.070 --> 00:05:35.150 position:50% align:middle There were dozens of correspondence schools for physicians, and there were virtually no standards. 00:05:35.150 --> 00:05:41.570 position:50% align:middle This would all change in the end of the 19th century, amidst the scientific revolution, 00:05:41.570 --> 00:05:51.210 position:50% align:middle and physicians who used the power of science to argue state legislators that they had a unique and 00:05:51.210 --> 00:05:58.574 position:50% align:middle specialized body of knowledge that needed to be codified into Medical Practice Acts. 00:05:58.574 --> 00:06:02.090 position:50% align:middle They were successful, and that would then be one of the factors that would 00:06:02.090 --> 00:06:07.780 position:50% align:middle help change medical education into a university-based model. 00:06:07.780 --> 00:06:11.090 position:50% align:middle So, why is any of this relevant to nursing? 00:06:11.090 --> 00:06:14.880 position:50% align:middle Because as I mentioned, it was the same template we used. 00:06:14.880 --> 00:06:19.350 position:50% align:middle Although, of course, physicians had one thing going for them, most, 00:06:19.350 --> 00:06:24.740 position:50% align:middle but not all of them were white men, meaning that they could vote in that era, 00:06:24.740 --> 00:06:30.230 position:50% align:middle and the trained nurses who made up the self-proclaimed elite in nursing, most but, again, certainly, 00:06:30.230 --> 00:06:33.520 position:50% align:middle not all of whom were white, could not. 00:06:33.520 --> 00:06:36.970 position:50% align:middle Male doctors had political power that nurses didn't. 00:06:36.970 --> 00:06:45.120 position:50% align:middle And once approved, those physicians who oversaw Medical Practice Acts had a strong stake in keeping nursing 00:06:45.120 --> 00:06:47.750 position:50% align:middle regulation under their purview. 00:06:47.750 --> 00:06:54.350 position:50% align:middle They and legislators were much less comfortable with notions of professional autonomy for a 00:06:54.350 --> 00:07:00.350 position:50% align:middle woman's profession, and reading their language this era, you can see their ambivalence about giving women 00:07:00.350 --> 00:07:02.690 position:50% align:middle too much authority. 00:07:02.690 --> 00:07:08.570 position:50% align:middle And another aside, because physicians got there first in terms of Practice Acts, 00:07:08.570 --> 00:07:15.370 position:50% align:middle they could and did pull some tasks that fell in the purview of others such as apothecaries, 00:07:15.370 --> 00:07:22.280 position:50% align:middle who would later be pharmacists, and nurses into the domain of Medical Practice Acts, 00:07:22.280 --> 00:07:29.970 position:50% align:middle because they believed that work should fall under the purview of medicine because they simply thought so or 00:07:29.970 --> 00:07:33.050 position:50% align:middle because they could charge for them or for whatever reason. 00:07:33.050 --> 00:07:40.380 position:50% align:middle And I say this because, when you look at these acts, historically, you can see that the domains of knowledge 00:07:40.380 --> 00:07:46.200 position:50% align:middle and practice were not for ordained, but they were shaped by cultural and political forces 00:07:46.200 --> 00:07:52.180 position:50% align:middle that once they became locked in, they were considered normative and often very 00:07:52.180 --> 00:07:53.760 position:50% align:middle difficult to change. 00:07:53.760 --> 00:07:58.160 position:50% align:middle And that's been a big part of our journey in American nursing. 00:07:58.160 --> 00:08:06.520 position:50% align:middle By the 20th century, jumping back to nursing, there was an explosive growth in hospitals and hospital 00:08:06.520 --> 00:08:13.750 position:50% align:middle schools of nursing where students would learn and apprentice to become trained nurses. 00:08:13.750 --> 00:08:21.580 position:50% align:middle Nurse leaders hoped that developing state regulation could bring some order on the chaotic field of people 00:08:21.580 --> 00:08:29.840 position:50% align:middle who called themselves professional nurses and be successful as Medical Practice Acts had 00:08:29.840 --> 00:08:32.550 position:50% align:middle been for physicians. 00:08:32.550 --> 00:08:37.910 position:50% align:middle Like 19th-century medical education, early 20th-century nursing education 00:08:37.910 --> 00:08:39.800 position:50% align:middle was really variable. 00:08:39.800 --> 00:08:43.670 position:50% align:middle It could be anything from six weeks to three years. 00:08:43.670 --> 00:08:50.690 position:50% align:middle Many specialty hospitals, such as children's hospitals, tuberculosis hospitals, psychiatric hospitals, 00:08:50.690 --> 00:08:55.810 position:50% align:middle would only educate students in the type of care that they provided at their hospital. 00:08:55.810 --> 00:09:01.710 position:50% align:middle And then after you graduated, one or two nurses might stay on and supervise the 00:09:01.710 --> 00:09:06.840 position:50% align:middle next group of students, but most would go out and provide care to people 00:09:06.840 --> 00:09:10.900 position:50% align:middle in their homes, in called private duty nursing. 00:09:10.900 --> 00:09:17.180 position:50% align:middle Running alongside this vein is the development of public health nursing, 00:09:17.180 --> 00:09:23.000 position:50% align:middle pioneered by Lilian Wald and her Henry Street Settlement in New York City. 00:09:23.000 --> 00:09:30.000 position:50% align:middle So nurse leaders wanted to bring some of the order to nursing practice that medicine had just accomplished. 00:09:30.000 --> 00:09:35.200 position:50% align:middle But as I mentioned, they couldn't vote, and it's also important to note that this wasn't just 00:09:35.200 --> 00:09:36.750 position:50% align:middle happening in the U.S. 00:09:36.750 --> 00:09:42.830 position:50% align:middle It's happening all around the world, in discussions that were largely occurring through the 00:09:42.830 --> 00:09:45.530 position:50% align:middle International Council of Nursing. 00:09:45.530 --> 00:09:51.620 position:50% align:middle And I understand there's a new history out of the ICN that I haven't had a chance to take a look at yet, 00:09:51.620 --> 00:09:55.440 position:50% align:middle but I'm very anxious to. 00:09:55.440 --> 00:10:04.680 position:50% align:middle But early 20th century, American nurse leaders, such as Isabel Hampton Robb and Adelaide Nutting, 00:10:04.680 --> 00:10:11.660 position:50% align:middle Lavinia Dock, were part of those ICN discussions and attending those meetings. 00:10:11.660 --> 00:10:16.760 position:50% align:middle So Pennsylvania nurse leaders, in their battle for nurse registration, 00:10:16.760 --> 00:10:21.260 position:50% align:middle began as early as 1904 with a bill. 00:10:21.260 --> 00:10:26.220 position:50% align:middle It would take them five years, until 1909, for it to become a law. 00:10:26.220 --> 00:10:28.890 position:50% align:middle They immediately had to jettison. 00:10:28.890 --> 00:10:35.980 position:50% align:middle They followed New York, that had just passed a registration act and had tried to get nurse 00:10:35.980 --> 00:10:39.990 position:50% align:middle registration mandatory and had abjectly failed. 00:10:39.990 --> 00:10:46.490 position:50% align:middle So that was the first thing the Pennsylvania nurse leaders jettisoned, much to their disappointment, 00:10:46.490 --> 00:10:48.700 position:50% align:middle but they knew they couldn't get it through. 00:10:48.700 --> 00:10:52.470 position:50% align:middle Registration would have to be voluntary. 00:10:52.470 --> 00:10:59.370 position:50% align:middle And there was strong opposition to nurse registration, particularly mandatory registration. 00:10:59.370 --> 00:11:06.120 position:50% align:middle It came from hospitals, but it also came within the ranks of nurses themselves, 00:11:06.120 --> 00:11:11.680 position:50% align:middle because those Pennsylvania nurse leaders, most of whom hailed from Philadelphia and Pittsburgh, 00:11:11.680 --> 00:11:21.960 position:50% align:middle wanted to set a standard curriculum that students would pay for that many people couldn't afford to pay for and 00:11:21.960 --> 00:11:26.480 position:50% align:middle that many hospitals just simply couldn't meet. 00:11:26.480 --> 00:11:33.710 position:50% align:middle And those self-proclaimed elite nurses, they were pretty high-handed and insensitive to the 00:11:33.710 --> 00:11:42.490 position:50% align:middle rank-and-file nurses and hospitals and what this might mean for them, that they might be put out of work 00:11:42.490 --> 00:11:46.130 position:50% align:middle because their school didn't meet the standard. 00:11:46.130 --> 00:11:55.120 position:50% align:middle And so despite a major campaign by those nurse leaders to do so, only 5% of Pennsylvania's nurses wrote 00:11:55.120 --> 00:12:01.350 position:50% align:middle to their legislators in support of the bill that became the 1909 law. 00:12:01.350 --> 00:12:04.270 position:50% align:middle And so it had very weak support. 00:12:04.270 --> 00:12:07.090 position:50% align:middle It would only call for voluntary registration. 00:12:07.090 --> 00:12:12.160 position:50% align:middle It protected the title of registered nurse, but it had a strongly-positioned 00:12:12.160 --> 00:12:14.290 position:50% align:middle control enforcement board. 00:12:14.290 --> 00:12:24.710 position:50% align:middle So that's the state of things when the 1918 flu begins in Pennsylvania, and historians have written, actually, 00:12:24.710 --> 00:12:33.030 position:50% align:middle quite a lot about Philadelphia's reactive, highly politicized, and disastrous response to the 00:12:33.030 --> 00:12:37.070 position:50% align:middle 1918 flu pandemic. 00:12:37.070 --> 00:12:40.120 position:50% align:middle So I'm just going to tell you a little bit about it briefly. 00:12:40.120 --> 00:12:49.390 position:50% align:middle But World War I had already depleted the city of a quarter of the city's physicians and a full one-third 00:12:49.390 --> 00:12:54.180 position:50% align:middle of the city's nurses were away serving during World War I. 00:12:54.180 --> 00:13:01.130 position:50% align:middle The city was more crowded than usual because it was a major industrial base and because it was also a port 00:13:01.130 --> 00:13:05.300 position:50% align:middle where soldiers left for Europe. 00:13:05.300 --> 00:13:10.650 position:50% align:middle And as the flu spread around the United States, by the third week in September 1918, 00:13:10.650 --> 00:13:17.940 position:50% align:middle there were already hundreds of soldiers sick with the flu in the Philadelphia Navy Yard. 00:13:17.940 --> 00:13:26.250 position:50% align:middle But despite that, Philadelphia went ahead with...succumbed to political pressure to raise money 00:13:26.250 --> 00:13:32.840 position:50% align:middle for the war effort and had what we today would call a superspreader event. 00:13:32.840 --> 00:13:36.010 position:50% align:middle You can see all those people, you know, standing. 00:13:36.010 --> 00:13:41.336 position:50% align:middle This is the center of the city, looking south from Philadelphia's city hall. 00:13:41.400 --> 00:13:53.170 position:50% align:middle And the reason for why there was such pressure was that Philadelphia had long considered itself among the first 00:13:53.170 --> 00:14:00.890 position:50% align:middle tier of cities in the United States, and they had long been supplanted by New York and more 00:14:00.890 --> 00:14:08.340 position:50% align:middle recently supplanted by Chicago and were feeling very, very insecure about their place as a leading city. 00:14:08.340 --> 00:14:12.700 position:50% align:middle And they wanted to really raise a lot of money for the war effort. 00:14:12.700 --> 00:14:19.350 position:50% align:middle Within a couple of weeks, there were thousands of people that were ill and dying. 00:14:19.350 --> 00:14:26.710 position:50% align:middle Just an aside, they thought it was a bacteria because they really didn't have any good understanding 00:14:26.710 --> 00:14:27.600 position:50% align:middle of a virus. 00:14:27.600 --> 00:14:34.380 position:50% align:middle And they could see a bacteria on a microscope, but it wouldn't be until the 1930s when they had 00:14:34.380 --> 00:14:37.680 position:50% align:middle an electron microscope that they could even see a virus. 00:14:37.680 --> 00:14:41.830 position:50% align:middle So they had no real idea what they were dealing with. 00:14:41.830 --> 00:14:52.510 position:50% align:middle So within weeks, there were hundreds dying, thousands sick, and then, soon, thousands dying. 00:14:52.510 --> 00:15:01.440 position:50% align:middle This just shows you some of the beds and some of the newspapers. 00:15:01.440 --> 00:15:07.500 position:50% align:middle Philadelphia would close its schools, its theaters, its houses of worship, 00:15:07.500 --> 00:15:11.740 position:50% align:middle and it would mount a public health campaign, but it was far too little, 00:15:11.740 --> 00:15:17.930 position:50% align:middle far too late to prevent the spread of the flu. 00:15:17.930 --> 00:15:24.480 position:50% align:middle And then just briefly to give you a sense of what nurse's work looked like, it was not very high tech, 00:15:24.480 --> 00:15:29.870 position:50% align:middle according to our standards today, but it was very labor intensive. 00:15:29.870 --> 00:15:37.320 position:50% align:middle It was mostly fresh air, keeping patients clean, ice packs and aspirin for fever, 00:15:37.320 --> 00:15:48.880 position:50% align:middle opiates to reduce cough, cooking specific foods, and then making poultices such as mustard plasters. 00:15:48.880 --> 00:15:57.960 position:50% align:middle But the infection would quickly overwhelm the city's ability to even maintain basic municipal services such 00:15:57.960 --> 00:16:01.990 position:50% align:middle as policing, firefighting, and garbage collection. 00:16:01.990 --> 00:16:07.600 position:50% align:middle Those people just didn't show up for their jobs or they were sick themselves and dying. 00:16:07.600 --> 00:16:11.640 position:50% align:middle Bodies began to pile up in the streets. 00:16:11.640 --> 00:16:14.100 position:50% align:middle It was really apocalyptic in Philadelphia. 00:16:14.100 --> 00:16:22.240 position:50% align:middle The city ran out of coffins, and then they ran out of wood to build coffins. 00:16:22.240 --> 00:16:25.390 position:50% align:middle Family after family were affected. 00:16:25.390 --> 00:16:28.900 position:50% align:middle The city's infrastructure simply crumbled. 00:16:28.900 --> 00:16:39.340 position:50% align:middle At one point, a public health leader, a physician in charge of Philadelphia's response 00:16:39.340 --> 00:16:45.930 position:50% align:middle responded to the dire crisis of nurses to care for all these sick people by saying, 00:16:45.930 --> 00:16:51.970 position:50% align:middle "If you would ask me the three things Philadelphia needs most to conquer this epidemic, 00:16:51.970 --> 00:16:56.740 position:50% align:middle I would tell you nurses, nurses, and yet more nurses. 00:16:56.740 --> 00:16:58.460 position:50% align:middle Doctors we have enough of. 00:16:58.460 --> 00:17:00.240 position:50% align:middle Supplies are plentiful. 00:17:00.240 --> 00:17:02.480 position:50% align:middle Buildings are offered us everywhere. 00:17:02.480 --> 00:17:05.830 position:50% align:middle We have many beds that might be open to students. 00:17:05.830 --> 00:17:11.880 position:50% align:middle But without enough nurses to tend those we already have, we're helpless." 00:17:11.880 --> 00:17:20.870 position:50% align:middle External groups, such as the Council of National Defense that was coordinating war efforts and the 00:17:20.870 --> 00:17:29.720 position:50% align:middle Red Cross, quickly moved into Philadelphia to try and bring nurses from outside to care for the sick, 00:17:29.720 --> 00:17:35.240 position:50% align:middle but there was really poor coordination because nobody was really in charge. 00:17:35.240 --> 00:17:41.560 position:50% align:middle The need for nurses was desperate and unremitting, October, November 1918. 00:17:41.560 --> 00:17:46.060 position:50% align:middle Most of the sick were cared for at home. 00:17:46.060 --> 00:17:56.350 position:50% align:middle It wasn't unusual for nurses to go to 40 different houses a day to arrive at a home with a dead parent, 00:17:56.350 --> 00:18:06.770 position:50% align:middle with sick children or babies sitting next to them, who had been not cared for or fed for hours or days. 00:18:06.770 --> 00:18:14.940 position:50% align:middle In fact, the nursing situation became so dire that people would follow nurses to their houses and 00:18:14.940 --> 00:18:21.790 position:50% align:middle coerce/beg them to come with them to care for their sick family members. 00:18:21.790 --> 00:18:29.710 position:50% align:middle And of course, many nurses and nursing students were getting sick and dying themselves. 00:18:29.710 --> 00:18:35.290 position:50% align:middle But here's one thing that didn't break down despite that catastrophe. 00:18:35.290 --> 00:18:43.970 position:50% align:middle Despite everything I've described to you, Philadelphia's segregated social and healthcare system 00:18:43.970 --> 00:18:46.340 position:50% align:middle remained largely intact. 00:18:46.340 --> 00:18:53.670 position:50% align:middle Black flu victims in Philadelphia were cared for by black nurses and black physicians, in black hospitals, 00:18:53.670 --> 00:18:57.900 position:50% align:middle such as Frederick Douglass and Mercy hospitals. 00:18:57.900 --> 00:19:06.830 position:50% align:middle And so it shows how deeply interwoven into the culture segregation was, even in a northern city that long 00:19:06.830 --> 00:19:11.940 position:50% align:middle prided itself on being enlightened and politically progressive. 00:19:11.940 --> 00:19:20.100 position:50% align:middle There was no question that those lines would be crossed and an available black nurse or black physician would 00:19:20.100 --> 00:19:24.350 position:50% align:middle care for a white patient, or vice versa. 00:19:24.350 --> 00:19:33.070 position:50% align:middle As the pandemic unfolded, Philadelphia's leaders, and along with the Philadelphia and Pennsylvania 00:19:33.070 --> 00:19:41.650 position:50% align:middle Health Department, quickly realized a surprising and unintended benefit of nurse registration, even though, 00:19:41.650 --> 00:19:45.080 position:50% align:middle as I mentioned, it was controversial and not mandatory. 00:19:45.080 --> 00:19:52.590 position:50% align:middle It was the only central repository of nursing personnel in Pennsylvania, both those who were registered and 00:19:52.590 --> 00:19:55.540 position:50% align:middle those who wanted to be registered. 00:19:55.540 --> 00:20:04.450 position:50% align:middle The council could then use this list to figure out where nurses were and try and move them around. 00:20:04.450 --> 00:20:12.200 position:50% align:middle They also were able to identify nurses of color through this list that they couldn't identify through the 00:20:12.200 --> 00:20:20.610 position:50% align:middle Red Cross, which also kept such lists because nurses of color and men could not join the Red Cross 00:20:20.610 --> 00:20:21.490 position:50% align:middle during this era. 00:20:21.490 --> 00:20:31.551 position:50% align:middle So that was not nearly as useful as those lists of nurses who were registered and wanted to be registered. 00:20:31.551 --> 00:20:33.780 position:50% align:middle And I'll just put up this slide. 00:20:33.780 --> 00:20:41.890 position:50% align:middle This is an early sort of...this was some of the early data that would inform the power of social distancing. 00:20:41.890 --> 00:20:47.900 position:50% align:middle You can see that this is, you know, the death rate of Philadelphia. 00:20:47.900 --> 00:20:54.970 position:50% align:middle It was so much higher than so many other cities in which things were similar, lots of poor people, 00:20:54.970 --> 00:21:06.950 position:50% align:middle you know, crowded tenement districts, congested cities, shortages of nurses and doctors. 00:21:06.950 --> 00:21:12.900 position:50% align:middle So in the wake of the pandemic, those leaders in Pennsylvania felt like they were 00:21:12.900 --> 00:21:18.250 position:50% align:middle on top of the world, both because of the war and because of the pandemic. 00:21:18.250 --> 00:21:25.290 position:50% align:middle They believed that they had demonstrated the critical importance of nurses, and they moved to, again, 00:21:25.290 --> 00:21:32.090 position:50% align:middle amend the Practice Act and upgrade the educational standards for nurses. 00:21:32.090 --> 00:21:41.070 position:50% align:middle But again, they did so without linking nursing education to science nor a clear rationale for why this 00:21:41.070 --> 00:21:50.010 position:50% align:middle should happen, or, again, trying to bring nurses together. 00:21:50.010 --> 00:21:51.550 position:50% align:middle They didn't lean into the fact, 00:21:51.550 --> 00:21:59.760 position:50% align:middle what everyone agreed on is that a central repository of nursing, a list of nurses, would be very, very useful, 00:21:59.760 --> 00:22:04.780 position:50% align:middle and from that, perhaps, they could build their next step. 00:22:04.780 --> 00:22:07.870 position:50% align:middle They just ignored that. 00:22:07.870 --> 00:22:12.800 position:50% align:middle Of course, ultimately, licensure would become mandatory. 00:22:12.800 --> 00:22:22.280 position:50% align:middle We would develop Nursing Practice Acts across all 50 states, and we would have exams to become a nurse. 00:22:22.280 --> 00:22:24.310 position:50% align:middle I know I don't need to tell this group that. 00:22:24.310 --> 00:22:28.057 position:50% align:middle And the NCSBN was founded. 00:22:30.520 --> 00:22:39.640 position:50% align:middle So as 2020 and 2021 fade into history, it won't be long until it seems as distant to 1918, 00:22:39.640 --> 00:22:41.890 position:50% align:middle at least to young people. 00:22:41.890 --> 00:22:46.270 position:50% align:middle I doubt that it will to most of us in this room. 00:22:46.270 --> 00:22:53.450 position:50% align:middle As a historian, I want to applaud what you did that'll shape the future in positive ways that our forebears 00:22:53.450 --> 00:22:55.740 position:50% align:middle didn't 100 years ago. 00:22:55.740 --> 00:23:01.720 position:50% align:middle First of all, I've already mentioned, leaders kept focusing on upgrading and standardizing 00:23:01.720 --> 00:23:05.970 position:50% align:middle nursing education without a clear rationale to the public. 00:23:05.970 --> 00:23:11.900 position:50% align:middle But you used the crisis as an opportunity to engage with broader societal issues such as the 00:23:11.900 --> 00:23:15.140 position:50% align:middle underrepresentation of men and nurses in color in the U.S. 00:23:15.140 --> 00:23:21.700 position:50% align:middle You documented it clearly as well as its importance. 00:23:21.700 --> 00:23:28.810 position:50% align:middle In 1919, even in the northern states, nurses attempting to amend Practice Acts rarely 00:23:28.810 --> 00:23:35.340 position:50% align:middle mentioned segregation, the barriers to nurses of color of becoming registered, 00:23:35.340 --> 00:23:41.790 position:50% align:middle which were formal, and by law, in the south, and in many places, by custom, in the north. 00:23:41.790 --> 00:23:49.990 position:50% align:middle And also, to men, it was a real catch-22 for men who were nurses because, at most nursing schools, 00:23:49.990 --> 00:23:56.340 position:50% align:middle men could not do an obstetric rotation, and in order to become a registered nurse in almost 00:23:56.340 --> 00:24:04.760 position:50% align:middle every state, you had to have an obstetrics rotation. 00:24:04.760 --> 00:24:08.230 position:50% align:middle Second, you generated and used data. 00:24:08.230 --> 00:24:14.420 position:50% align:middle In the wake of 1918, the flu, nurses in Pennsylvania did not do that. 00:24:14.420 --> 00:24:15.290 position:50% align:middle They could have. 00:24:15.290 --> 00:24:23.300 position:50% align:middle Indeed, it was Florence Nightingale whose statistics on morbidity, on mortality in the Crimean War had helped 00:24:23.300 --> 00:24:30.230 position:50% align:middle usher in a whole new era of statistics, not just in nursing but in public health. 00:24:30.230 --> 00:24:35.250 position:50% align:middle In the wake of the 1918 flu, nurse leaders assumed that all the great press that 00:24:35.250 --> 00:24:41.270 position:50% align:middle nurses had gotten from the war and from the pandemic would pay off. 00:24:41.270 --> 00:24:45.390 position:50% align:middle But public valorization can be fleeting. 00:24:45.390 --> 00:24:51.040 position:50% align:middle When epidemics subside, that valorization can be quickly tempered by economic 00:24:51.040 --> 00:24:55.220 position:50% align:middle forces and previous interdisciplinary conflicts. 00:24:55.220 --> 00:24:59.399 position:50% align:middle And that is exactly what happened in Pennsylvania. 00:25:00.510 --> 00:25:09.080 position:50% align:middle The 1919 Registration Act looked very similar to prior ones. 00:25:09.080 --> 00:25:15.210 position:50% align:middle They got a few additional nurses on the board. 00:25:15.210 --> 00:25:21.230 position:50% align:middle But your group saw the wisdom of tracking...sorry. 00:25:21.230 --> 00:25:25.490 position:50% align:middle Again, they didn't lean into the data that they had. 00:25:25.490 --> 00:25:31.050 position:50% align:middle But spending time with your workforce report and your report on the use of students, 00:25:31.050 --> 00:25:37.690 position:50% align:middle nursing students, during COVID, you documented, first of all, not only in real time, 00:25:37.690 --> 00:25:47.690 position:50% align:middle important issues related to COVID, also, issues that really mattered to nurses, 00:25:47.690 --> 00:25:52.390 position:50% align:middle all different types of nurses, as well as to the American public, 00:25:52.390 --> 00:26:00.070 position:50% align:middle such as staffing challenges, nurse burnout, and again, issues of diversity important to the profession. 00:26:00.070 --> 00:26:07.650 position:50% align:middle So, in other words, I think your sophisticated efforts don't just assume that society is going to reward 00:26:07.650 --> 00:26:11.380 position:50% align:middle nurses for their efforts during the COVID-19 pandemic. 00:26:11.380 --> 00:26:19.120 position:50% align:middle You've provided them with data and rationale and a roadmap for what needs to happen and why. 00:26:19.120 --> 00:26:24.280 position:50% align:middle But one final caveat, one of the things we can see from history, 00:26:24.280 --> 00:26:26.930 position:50% align:middle data alone is never enough. 00:26:26.930 --> 00:26:33.180 position:50% align:middle You also need to have a political voice and capture and mobilize unheard voices. 00:26:33.180 --> 00:26:38.510 position:50% align:middle And again, I think your materials make it possible for nurses to do this. 00:26:38.510 --> 00:26:48.580 position:50% align:middle Those nurses in 1919 did not yet have the vote, and it would not be decades that both men and women 00:26:48.580 --> 00:26:54.180 position:50% align:middle of color everywhere in the United States would be able to vote. 00:26:54.180 --> 00:27:02.960 position:50% align:middle There were also barriers to other ethnicities, such as, for example, Chinese people could not achieve 00:27:02.960 --> 00:27:08.500 position:50% align:middle citizenship in the United States until the 1960s by law. 00:27:08.500 --> 00:27:18.830 position:50% align:middle So I put up here some of the tools that we used to do our study that, if anyone's interested in looking 00:27:18.830 --> 00:27:25.780 position:50% align:middle at their state or using this as a student assignment, you can also email me. 00:27:25.780 --> 00:27:31.810 position:50% align:middle My email address, you can just go on the UPenn website and find my email address. 00:27:31.810 --> 00:27:38.120 position:50% align:middle And I'd be happy to answer any questions that you might have about how to go about it 00:27:38.120 --> 00:27:39.850 position:50% align:middle for your particular state. 00:27:39.850 --> 00:27:41.920 position:50% align:middle Those first two are particularly helpful. 00:27:41.920 --> 00:27:50.790 position:50% align:middle We have lots of materials on our website, and the University of Michigan has a fantastic database 00:27:50.790 --> 00:27:58.000 position:50% align:middle that has hundreds of thousands of newspaper articles and other materials from all around the U.S. 00:27:58.000 --> 00:28:06.280 position:50% align:middle And so I'm just going to end by thanking you for showing the profession and society what a responsive 00:28:06.280 --> 00:28:14.110 position:50% align:middle regulatory approach to a crisis can look like, one that shapes a brilliant future. 00:28:14.110 --> 00:28:15.731 position:50% align:middle Thank you so much.