Friday, November 21, 2008

Nurses Who Serve Those Who Serve

By Linda S. Smith, MS, DSN, RN, CLNC
Professor and Director of the Associate Degree Registered Nurse Program at the College of Technology, Idaho State University

Last year, New Jersey born Army Captain Maria Ines Ortiz was the first army nurse to be killed in Iraq since the 2003 US invasion. She was killed during a mortar attack in Baghdad’s Green Zone. Ortiz was doing what military nurses do best – caring for the sick and wounded on or near enemy lines. She was survived by her parents, four sisters, and a fiance’. Ortiz gave her professional nursing skills and dedication, as well as her life, to serve those who so selflessly and heroically serve us.

Many of us consider great military nursing to have originated with Britain’s Florence Nightingale. It is true that the events in Scutari, Turkey gave birth to professional nursing. It is not true that Scutari was the first military location for nurses. For America, military nursing officially began with the birth of our country - the revolutionary war.

Nursing during the Revolutionary War (1776) was not recognized as a separate and distinct service. It was often included and described along with such tasks as cooking, cleaning, washing, and sewing. “Nursing” was designed to keep sick men clean, well fed, and comfortable. Camp followers on both sides of the war effort were women who washed, cleaned, cooked, and “nursed” the men. And medical care given to the wounded included purging, blistering, and bleeding. Most battle wounds were followed by uncontrolled infections, forcing surgeons to amputate. Over 90% of deaths were caused by disease – 10% by battle wounds. Wounded men would be placed side by side with men suffering typhoid and typhus, thus wiping out whole wards.

The Civil War

In 1861, President Abraham Lincoln called for volunteers to help care for sick and injured Union Soldiers. Simultaneously, women in the north began to organize relief societies. Dorthea L. Dix came to Washington, DC to volunteer her services and was immediately appointed superintendent of women nurses of the Army. (Dix had already made significant contributions to the improvement of care for the mentally ill). Dix established strict criteria for her nurses, with the idea that these women would be nursing supervisors. Her nurses were sent to Bellevue Hospital New York City, for one month of training. Clara Barton, founder of the American Red Cross, began her Civil war work in 1861 when she established an agency to distribute medical supplies to wounded soldiers.

Though enormously dedicated, hardworking, and successful, the idea of female nurses was met with opposition from male doctors and military personnel. These nurses were often outspoken about incompetence, pilfering, and corruption among army surgeons. Many hospitals had little food and even fewer supplies. Nurses wrote to their contacts and reported these terrible conditions – further angering the male physicians. They took cleanliness and organization into their own hands.

Transport services for sick and wounded men were available via railroad, steam ships and wagons, often taking days and even weeks to reach hospitals. Tents were pitched along waterways where a corp of male and female nurses worked. Religious sisters also became a vital part of the nursing staff.

Importantly, medical efforts during the Civil war led to many scientific improvements and paved the way for a new profession of nursing in the US.

Scutari and Florence Nightingale

Florence Nightingale’s best-known triumph, the organization of military nursing, took place during the Crimean War (named after Turkey’s Crimean Peninsula). In 1854, Great Britain and France declared war on Russia in order to protect Turkey from Russian attacks. Due to poor military decisions, fierce fighting and enormous numbers of causalities from wounds, cholera, and dysentery, men were dying by the thousands. Four miles of the Turkish “Barrack Hospital” housed Great Britain’s sick and dying soldiers. British people were outraged, as news of these atrocities reached England, and the Secretary of State Sidney Herbert asked his long time friend Florence Nightingale to organize a group of nurses for war service in Turkey.

Nightingale saw four miles of rat-infested corridors filled with starving, freezing men. They had no blankets, beds, or bandages. Amputations were performed without anesthetic or even the crudest sanitation. Nightingale and her 38 nurses arrived on November 5, 1854 and were given charge of 1,500 patients. In only a few months, Nightingale decreased the death rate from 42% to 2%. She transformed the Barracks into efficiently run hospitals and won the admiration and respect of the world.

Nightingale understood medical and military politics and the scientific method for gathering and reporting data. Advocating for the sick and wounded soldiers, Nightingale used her statistical and writing skills to influence increased funding and appropriations of supplies. The grateful British people donated $200,000 to her, which she used to start the Nightingale School of Nursing four years later in 1860.

Spanish American War

For the first time in US history, professionally trained nurses were accepted into military hospitals. During the Spanish American War, these contract nurses became forerunners to our present military nursing corp. The Spanish American War took place against Spain (Cuba) in 1898 and the first call for nurses came on May 7, 1898 because of the 30% sick rate among American troops. Typhoid patients would remain for hours and even days without care. Some had bedsores down to the bone. Because of the resistance to having female nurses, these health professionals knew they had to excel in every possible way. One single nurse often had to care for 40 or more delirious typhoid patients per day. Nurses worked at a frantic pace in unfurnished facilities. They also helped gather statistics and medical data related to typhoid – statistics implicating the contaminated water, food, and insects.

These trained nurses were considered by the men as angels of mercy. Thus, in December of 1898, a committee of women and nurses moved to establish a permanent Army Nurse Corp. In 1901, the Army Nurse Corp was established. In 1908 the Navy Nurse Corp (the only females in the Navy) became an important component of the US Navy. They won the praise and admiration of navel officials because, for the first time, two large nursing services were made up entirely of graduate nurses.

World War I

The US committed itself to WWI in 1917 and our Army and Navy Nurse Corp increased their numbers significantly to meet the needs of the American soldiers. Unfortunately, as our nation faced a devastating flu epidemic at home, more and more civilian nurses were leaving for military and Red Cross service. Therefore, student nurse recruitment efforts were increased.

Conditions in camp hospitals were difficult. However, World War I provided nurses with experience related to the new projectile bullets, shell fragments, poison gas, explosives, and other injury causing war machines. Nurses learned to use a weak chlorine solution for cleansing wound infections, and developed debriedment operations. Almost 300 nurses died in WW I, mostly due to disease exacerbated by overwork.

World War II

On December 7, 1941, Japanese pilots bombed Pearl Harbor and so began America’s involvement in WWII. Even before that date, however, the Nursing Council on National Defense was organized. Composed of representatives from the six American nursing organizations, this committee set out to recruit more student nurses, improve nursing education, decrease the numbers of inactive nurses, and educate and use voluntary nurses’ aides.

As with WWI, the war effort created a major civilian nursing shortage. A national plan for federal financial aid allowed schools of nursing to provide scholarships to needy student nurses and for refresher courses for inactive nurses. On July 1, 1943, a nursing student could join the Cadet Nurse Corp, receive full scholarships and a small monthly stipend. In return she had to promise to serve as a military nurse after graduation. Thus, students could complete their nursing education AND serve their country. Notably, and as a result of this national effort, nursing schools voluntarily upgraded curriculum and faculty to meet the military standards.

With the Cadet Nurse Corp and its 150,000 members, the concept of aid to nursing education became reality and civilian and military nursing collaborated. WW II also brought about the important idea of placing medical and nursing services as close to the war front as possible. The type of firepower used created more casualties but mortality was decreased because of the high medical standards and nursing services. By the end of the war, 100,000 nurses had volunteered for military service. Nurses went ashore with the invading troops and were placed where their special skills were most needed.

Today

Today, a career as a nurse in the military means that a nurse’s educational advancement and career goals can be met through military service. Experiences in state-side military hospitals and bases, as well as overseas duty positions, are available. Reserve nursing is also available to nurses who choose this type of military service.

American military nurses continue to stand firm in their beliefs and commitments for quality, efficient health care given to our nation’s sick and wounded military personnel. Just as was the case with New Jersey born Army Captain Maria Ines Ortiz, they are proving themselves as expert, valuable, dedicated nurses – they are bravely caring for and serving those who serve us.

References

Austin, A. L. (1975). Wartime volunteers-1861-1865. AJN, 75(5).
Berges, F. & Berges, C. (1986). A visit to Scutari. AJN, 86(7), 811-813.
Bullough, B. (1976). The lasting impact of WWII on nursing. AJN, 76(1).
Culpepper, M. M., & Adams, P. G. (1988). Nursing in the civil war. AJN. 88(7), 981-984.
Dolan, J. A. (1966). Goodnow’s history of nursing. Philadelphia: WB Saunders Co.
Kalisch, P. A., & Kalisch, B. J. (1978). The advance of American nursing. Boston: Little, Brown, and Co.
Selavan, I.C. (1975). Nurses in American history: The revolution. AJN, 75(4).

* Portions previously published Journal of Military Nursing Research, 1(2), 12-13, 1995

1 comment:

fairy said...

Thanks for the great post, I started my career in nursing after finishing a associate degree in nursing from associate degree nursing schools