By: Julie Fairman
This study addresses the reorganization of nursing care of the critically ill in hospitals of the 1950s and 1960s. Data is drawn primarily from the manuscript collections of 2 Philadelphia hospitals. Demand for nurses in the hospitals of the 1950s, created in part by increased hospitalization, through greater numbers of insured patients and public perceptions of the ability of medical science to cure, and complexity of patients in an inefficient architectural environment put critically ill patients at risk. The migratory and seasonal pattern of nursing employment, resulting in high turnover and large numbers of inexperienced nurses in hospitals, and the delay between changes in nursing practice and nursing education compounded the risk. Hospitals and nursing leaders responded by imitating nurses' traditional pattern of work, by gathering the sickest patients with a concentrated number of nurses in a separate space, the ideal of one nurse for one patient, watching all the time. Once grouped with critically ill patients, nurses' work changed. Nurses, realizing their lack of knowledge, gained expertise through experience and knowledge trades with physicians, and in the process gained authority to make and initiate treatment decisions, thus breaking physicians' monopoly on clinical decision-making and setting the stage for reform of nursing education and practice in the 1960s and 1970s.